Healthcare Provider Details

I. General information

NPI: 1114702651
Provider Name (Legal Business Name): JERSEY BEHAVIOR CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 PROSPECT RIDGE BLVD
HADDON HEIGHTS NJ
08035-1026
US

IV. Provider business mailing address

2007 PROSPECT RIDGE BLVD
HADDON HEIGHTS NJ
08035-1026
US

V. Phone/Fax

Practice location:
  • Phone: 609-760-5096
  • Fax:
Mailing address:
  • Phone: 609-760-5096
  • 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: MARY ELIZABETH O'BRIEN
Title or Position: OWNER
Credential: MA, BCBA, IBA
Phone: 609-760-5096