Provider Demographics
NPI:1700139961
Name:THE MISSING PIECE PARENTAL SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:THE MISSING PIECE PARENTAL SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BALESTRIERI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:732-598-8150
Mailing Address - Street 1:1811 A ST
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2621
Mailing Address - Country:US
Mailing Address - Phone:732-598-8150
Mailing Address - Fax:
Practice Address - Street 1:1811 A ST
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2621
Practice Address - Country:US
Practice Address - Phone:732-598-8150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health