Provider Demographics
NPI:1912485426
Name:APPLIED BEHAVIORAL AND EDUCATIONAL SERVICES LLC
Entity Type:Organization
Organization Name:APPLIED BEHAVIORAL AND EDUCATIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUNTZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:215-264-2347
Mailing Address - Street 1:167 COLMAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915-9710
Mailing Address - Country:US
Mailing Address - Phone:215-264-2347
Mailing Address - Fax:
Practice Address - Street 1:167 COLMAR AVE
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915-9710
Practice Address - Country:US
Practice Address - Phone:215-264-2347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-11-8553103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1518318658Medicaid