Provider Demographics
NPI:1013496264
Name:INTENTIONAL INTERVENTIONS, LLC
Entity Type:Organization
Organization Name:INTENTIONAL INTERVENTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:609-402-2720
Mailing Address - Street 1:125 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5796
Mailing Address - Country:US
Mailing Address - Phone:609-402-2720
Mailing Address - Fax:609-788-3617
Practice Address - Street 1:1501 S NEW RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3765
Practice Address - Country:US
Practice Address - Phone:609-380-1122
Practice Address - Fax:609-374-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-18-30938103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty