Healthcare Provider Details

I. General information

NPI: 1417505827
Provider Name (Legal Business Name): ABC SUPPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
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: 609-457-0126
  • Fax:
Mailing address:
  • Phone: 609-457-0126
  • 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
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH R DUMAS
Title or Position: PRESIDENT
Credential:
Phone: 609-457-0126