Provider Demographics
NPI:1932648086
Name:BEHAVIOR ANALYSIS AND SUPPORT SERVICES
Entity Type:Organization
Organization Name:BEHAVIOR ANALYSIS AND SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:201-851-2471
Mailing Address - Street 1:60 GRAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-6583
Mailing Address - Country:US
Mailing Address - Phone:551-800-2441
Mailing Address - Fax:844-364-3239
Practice Address - Street 1:60 GRAND AVE STE 1
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-6583
Practice Address - Country:US
Practice Address - Phone:201-849-4565
Practice Address - Fax:844-364-3239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11314553251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health