Healthcare Provider Details

I. General information

NPI: 1700464393
Provider Name (Legal Business Name): FAMILY MATTERS ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 ESSEX ST
EAST ORANGE NJ
07017-1305
US

IV. Provider business mailing address

21 ESSEX ST
EAST ORANGE NJ
07017-1305
US

V. Phone/Fax

Practice location:
  • Phone: 862-213-0334
  • Fax:
Mailing address:
  • Phone: 862-800-2569
  • Fax: 862-205-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MPHO TAU SELLO
Title or Position: OWNER/OPERATIONS MANAGER
Credential:
Phone: 862-213-0334