Healthcare Provider Details

I. General information

NPI: 1184326886
Provider Name (Legal Business Name): A FRESH START BEHAVIORAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 PINHORN DR
BRIDGEWATER NJ
08807-3520
US

IV. Provider business mailing address

3306 PINHORN DR
BRIDGEWATER NJ
08807-3520
US

V. Phone/Fax

Practice location:
  • Phone: 908-309-6446
  • Fax:
Mailing address:
  • Phone: 908-309-6446
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: LEIGHANN LORUSSO
Title or Position: CO-FOUNDER/BCBA
Credential: BCBA
Phone: 908-309-6446