Healthcare Provider Details

I. General information

NPI: 1386233559
Provider Name (Legal Business Name): ABC SUPPORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 WHIPPOORWILL DR
SICKLERVILLE NJ
08081-9332
US

IV. Provider business mailing address

17 WHIPPOORWILL DR
SICKLERVILLE NJ
08081-9332
US

V. Phone/Fax

Practice location:
  • Phone: 609-457-2511
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH DUMAS
Title or Position: PRESIDENT
Credential:
Phone: 609-457-2511