Healthcare Provider Details

I. General information

NPI: 1477336303
Provider Name (Legal Business Name): ACADEMIC GAINS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PEARL AVE
MOUNT LAUREL NJ
08054-2029
US

IV. Provider business mailing address

208 PEARL AVE
MOUNT LAUREL NJ
08054-2029
US

V. Phone/Fax

Practice location:
  • Phone: 609-553-1350
  • Fax:
Mailing address:
  • Phone:
  • 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: TIMOTHY M MCDANIELS JR.
Title or Position: CO-OWNER/CEO
Credential:
Phone: 609-922-4749