Provider Demographics
NPI:1982486700
Name:CEDAR TREE ABA LLC
Entity Type:Organization
Organization Name:CEDAR TREE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:
Authorized Official - Last Name:T
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-742-9171
Mailing Address - Street 1:301 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3266
Mailing Address - Country:US
Mailing Address - Phone:770-742-9171
Mailing Address - Fax:
Practice Address - Street 1:301 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3266
Practice Address - Country:US
Practice Address - Phone:770-742-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty