Healthcare Provider Details

I. General information

NPI: 1275213662
Provider Name (Legal Business Name): LEAD BEHAVIOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GREENTREE CTR
MARLTON NJ
08053-3422
US

IV. Provider business mailing address

33 OTTAWA AVE
HASBROUCK HEIGHTS NJ
07604-1408
US

V. Phone/Fax

Practice location:
  • Phone: 201-270-7594
  • Fax:
Mailing address:
  • Phone: 201-270-7594
  • 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: KAITLYN CONROY
Title or Position: PRESIDENT
Credential: BCBA
Phone: 201-270-7594