Provider Demographics
NPI:1750775946
Name:ABA GROUP PRACTICE PA
Entity type:Organization
Organization Name:ABA GROUP PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELVIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, EDD
Authorized Official - Phone:201-873-5575
Mailing Address - Street 1:1203 RIVER RD
Mailing Address - Street 2:9M
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1456
Mailing Address - Country:US
Mailing Address - Phone:201-873-5575
Mailing Address - Fax:201-254-8095
Practice Address - Street 1:1564 LEMOINE AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-5635
Practice Address - Country:US
Practice Address - Phone:201-794-9797
Practice Address - Fax:201-254-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052802001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty