Provider Demographics
NPI:1184435455
Name:MODIFYING BEHAVIOR LLC
Entity type:Organization
Organization Name:MODIFYING BEHAVIOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/BCBA
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:732-887-9376
Mailing Address - Street 1:794 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8706
Mailing Address - Country:US
Mailing Address - Phone:732-887-9376
Mailing Address - Fax:703-935-5966
Practice Address - Street 1:794 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8706
Practice Address - Country:US
Practice Address - Phone:732-887-9376
Practice Address - Fax:703-935-5966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODIFYING BEHAVIOR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health