Provider Demographics
NPI:1912309501
Name:BEHAVOIR ALTERNATIVES FOR SPECIAL KIDS, LLC
Entity Type:Organization
Organization Name:BEHAVOIR ALTERNATIVES FOR SPECIAL KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SALOME
Authorized Official - Middle Name:BRANAS
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, BCBA
Authorized Official - Phone:973-602-7108
Mailing Address - Street 1:60 BALDWIN ST
Mailing Address - Street 2:#7A
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2767
Mailing Address - Country:US
Mailing Address - Phone:973-602-7108
Mailing Address - Fax:
Practice Address - Street 1:60 BALDWIN ST
Practice Address - Street 2:#7A
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2767
Practice Address - Country:US
Practice Address - Phone:973-602-7108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-13-12904103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty