Provider Demographics
NPI:1811763162
Name:SUPPORT CARE BEHAVIORAL SERVICES
Entity type:Organization
Organization Name:SUPPORT CARE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:APAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-234-1791
Mailing Address - Street 1:13 WISTERIA DR APT 2C
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1112
Mailing Address - Country:US
Mailing Address - Phone:848-234-1791
Mailing Address - Fax:
Practice Address - Street 1:13 WISTERIA DR APT 2C
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1112
Practice Address - Country:US
Practice Address - Phone:848-234-1791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health