Healthcare Provider Details

I. General information

NPI: 1396653408
Provider Name (Legal Business Name): PINELANDS ABA CONNECTION LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BLACKHAWK CT
MEDFORD NJ
08055-9382
US

IV. Provider business mailing address

19 BLACKHAWK CT
MEDFORD NJ
08055-9382
US

V. Phone/Fax

Practice location:
  • Phone: 215-740-7373
  • Fax: 215-740-7373
Mailing address:
  • Phone: 215-740-7373
  • Fax: 215-740-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CAROLINE GRACE RYAN
Title or Position: OWNER
Credential: MS, BCBA, LBA
Phone: 215-740-7373