Provider Demographics
NPI:1912335316
Name:KG BAHAVIOR MODIFICATION LLC.
Entity Type:Organization
Organization Name:KG BAHAVIOR MODIFICATION LLC.
Other - Org Name:KIELIN GREELEY & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:GREELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-568-5619
Mailing Address - Street 1:158 RIVEREDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1955
Mailing Address - Country:US
Mailing Address - Phone:201-568-5619
Mailing Address - Fax:
Practice Address - Street 1:158 RIVEREDGE ROAD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1955
Practice Address - Country:US
Practice Address - Phone:201-655-4887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty