Provider Demographics
NPI:1770317075
Name:CLOVER CARE ABA LLC
Entity type:Organization
Organization Name:CLOVER CARE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-240-2147
Mailing Address - Street 1:180 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2332
Mailing Address - Country:US
Mailing Address - Phone:848-240-2147
Mailing Address - Fax:732-730-9661
Practice Address - Street 1:180 MILLER RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2332
Practice Address - Country:US
Practice Address - Phone:848-240-2147
Practice Address - Fax:732-730-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty