Healthcare Provider Details

I. General information

NPI: 1740594878
Provider Name (Legal Business Name): HOBAN AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 WINDING WAY
GLENSIDE PA
19038-2108
US

IV. Provider business mailing address

324 WINDING WAY
GLENSIDE PA
19038-2108
US

V. Phone/Fax

Practice location:
  • Phone: 215-572-5965
  • Fax: 215-887-8699
Mailing address:
  • Phone: 215-572-5965
  • Fax: 215-887-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-03-1135
License Number StatePA

VIII. Authorized Official

Name: MS. SUSAN HOBAN-DYE
Title or Position: PRESIDENT/BEHAVIOR ANALYST
Credential: BCBA
Phone: 215-572-5965