Healthcare Provider Details

I. General information

NPI: 1457086530
Provider Name (Legal Business Name): BE YOURSELF ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 JACKSON RD
MEDFORD NJ
08055-1127
US

IV. Provider business mailing address

26 ANTIS ST
PEMBERTON NJ
08068-1127
US

V. Phone/Fax

Practice location:
  • Phone: 640-600-4137
  • Fax: 609-543-2600
Mailing address:
  • Phone: 267-981-1645
  • 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

VIII. Authorized Official

Name: JESSICA SCHURSTEIN
Title or Position: CLINICAL DIRECTOR
Credential: MS, BCBA
Phone: 640-600-4137