Provider Demographics
NPI:1669117867
Name:OVATION BEHAVIOR GROUP
Entity type:Organization
Organization Name:OVATION BEHAVIOR GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:703-220-4678
Mailing Address - Street 1:20 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2630
Mailing Address - Country:US
Mailing Address - Phone:703-220-4678
Mailing Address - Fax:
Practice Address - Street 1:20 BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2630
Practice Address - Country:US
Practice Address - Phone:703-220-4678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health