Healthcare Provider Details

I. General information

NPI: 1487380242
Provider Name (Legal Business Name): AG BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RIVER ROAD SUITE 32 #313
RIDGEFIELD NJ
07657-1502
US

IV. Provider business mailing address

725 RIVER ROAD SUITE 32 #313
RIDGEFIELD NJ
07657-1502
US

V. Phone/Fax

Practice location:
  • Phone: 201-873-8611
  • Fax: 201-945-0562
Mailing address:
  • Phone: 201-873-8611
  • Fax: 201-945-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREA E GONZALEZ
Title or Position: OWNER
Credential: BCBA
Phone: 201-873-8611