Provider Demographics
NPI:1912587189
Name:PROGRESSIVE TRENDS LLC
Entity Type:Organization
Organization Name:PROGRESSIVE TRENDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:S & L THERAPIST AND BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBROSS
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP, BCBA
Authorized Official - Phone:732-713-4995
Mailing Address - Street 1:109 BEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8818
Mailing Address - Country:US
Mailing Address - Phone:732-713-4995
Mailing Address - Fax:
Practice Address - Street 1:109 BEAGLE DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8818
Practice Address - Country:US
Practice Address - Phone:732-713-4995
Practice Address - Fax:732-605-0568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty