Healthcare Provider Details

I. General information

NPI: 1144552621
Provider Name (Legal Business Name): BRAINBUILDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 RIVER AVE SUITE 201
LAKEWOOD NJ
08701-5606
US

IV. Provider business mailing address

945 RIVER AVE SUITE 201
LAKEWOOD NJ
08701-5606
US

V. Phone/Fax

Practice location:
  • Phone: 732-833-3723
  • Fax: 888-247-4390
Mailing address:
  • Phone: 732-833-3723
  • Fax: 888-247-4390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHEL SOROTZKIN
Title or Position: DIRECTOR
Credential: BCBA
Phone: 732-883-3723