Provider Demographics
NPI:1881475440
Name:KLUBHOUSE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:KLUBHOUSE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-205-5489
Mailing Address - Street 1:530 OFFALY LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-2773
Mailing Address - Country:US
Mailing Address - Phone:401-205-5489
Mailing Address - Fax:
Practice Address - Street 1:530 OFFALY LN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-2773
Practice Address - Country:US
Practice Address - Phone:401-205-5489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty