Healthcare Provider Details

I. General information

NPI: 1972221786
Provider Name (Legal Business Name): OUR CHILD THERAPY MA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 BOYLSON STREET
BOSTON MA
02116
US

IV. Provider business mailing address

211 BLVD OF THE AMERICAS SUITE 303
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 917-974-9300
  • Fax:
Mailing address:
  • Phone: 917-974-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MASHE MOSHE
Title or Position: OWNER
Credential:
Phone: 848-226-4806