MEDICARE: A&J BEHAVIORAL HEALTH

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	252Y00000X	Early Intervention Provider Agency	103K00000X	NY

General Provider Information

NPI Number	:	1790231645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&J BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	762 HART STREET
Second Line	:	APT 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11237
Country	:	US
Telephone Number	:	718-404-1652
Fax Number	:

Provider Business Practice Location Address
First Line	:	762 HART ST
Second Line	:	APT 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11237-3539
Country	:	US
Telephone Number	:	718-404-1652
Fax Number	:

Authorized Official
Title or Position	:	ABA THERAPIST
Name	:	MS. DEBBIE ROLON
Credential	:	M.S EDUCATION
Telephone Number	:	718-404-1652

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	08/31/2016

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