MEDICARE: THE GREGORY CENTER FOR APPLIED BEHAVIOR ANALYSIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	BH00047	PA

General Provider Information

NPI Number	:	1710385323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GREGORY CENTER FOR APPLIED BEHAVIOR ANALYSIS

Provider Business Mailing Address
First Line	:	17 STARK ST
Second Line	:
City	:	PITTSTON
State	:	PA
Zip	:	18640-2026
Country	:	US
Telephone Number	:	570-335-0357
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 STARK ST
Second Line	:
City	:	PITTSTON
State	:	PA
Zip	:	18640-2026
Country	:	US
Telephone Number	:	570-335-0357
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JODI GREGORY
Credential	:	BCBA, LBS
Telephone Number	:	570-335-0357

Provider Enumeration Date	:	12/12/2014
Last Update Date	:	12/12/2014

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Directions to “THE GREGORY CENTER FOR APPLIED BEHAVIOR ANALYSIS ” Practice Location

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