Healthcare Provider Details

I. General information

NPI: 1144818220
Provider Name (Legal Business Name): BEYOND THE SPECTRUM THERAPEUTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 10/05/2022
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 MAIN ST
LODI NJ
07644-1818
US

IV. Provider business mailing address

449 MAIN ST
LODI NJ
07644-1818
US

V. Phone/Fax

Practice location:
  • Phone: 201-825-4272
  • Fax:
Mailing address:
  • Phone: 201-509-1282
  • 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
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBRA DEMPSEY-CILIENTO
Title or Position: OWNER/OPERATOR
Credential:
Phone: 201-825-4272