Provider Demographics
NPI:1295251452
Name:IMPACT ABA SERVICES LLC
Entity type:Organization
Organization Name:IMPACT ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ERWINE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:973-906-0965
Mailing Address - Street 1:27 BEAVER BROOK LN
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-1304
Mailing Address - Country:US
Mailing Address - Phone:973-906-0965
Mailing Address - Fax:
Practice Address - Street 1:27 BEAVER BROOK LN
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-1304
Practice Address - Country:US
Practice Address - Phone:973-906-0965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty