Healthcare Provider Details

I. General information

NPI: 1811456890
Provider Name (Legal Business Name): STEP BY STEP BEHAVIORAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 BELMAR BLVD
WALL NJ
07719
US

IV. Provider business mailing address

915 BENNETTS MILL ROAD SUITE 705
JACKSON NJ
08527-4207
US

V. Phone/Fax

Practice location:
  • Phone: 631-213-5102
  • Fax:
Mailing address:
  • Phone: 631-213-5102
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA MARIE SIMON
Title or Position: PRESIDENT
Credential: LCSW, BCBA
Phone: 631-213-5102