Healthcare Provider Details

I. General information

NPI: 1730815622
Provider Name (Legal Business Name): APPLIED BEHAVIORAL SERVICES MASON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7413 SQUIRE CT
WEST CHESTER OH
45069-2313
US

IV. Provider business mailing address

2 VILLAGE SQ STE 210
BALTIMORE MD
21210-1624
US

V. Phone/Fax

Practice location:
  • Phone: 513-847-4685
  • Fax: 513-847-4763
Mailing address:
  • Phone: 609-525-4271
  • Fax: 410-415-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DEENA STEIN GREENBLATT
Title or Position: PAYOE ENROLLMENT & CONTRACTING
Credential:
Phone: 609-525-4271