Healthcare Provider Details

I. General information

NPI: 1124466479
Provider Name (Legal Business Name): BEHAVIORAL PEDIATRICS AND ABA THERAPY ASSOCIATES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 SUMNEYTOWN PIKE FIRST FLOOR OFFICE
LANSDALE PA
19446-4854
US

IV. Provider business mailing address

1020 ANDERS RD
LANSDALE PA
19446
US

V. Phone/Fax

Practice location:
  • Phone: 267-642-4039
  • Fax:
Mailing address:
  • Phone: 267-642-4039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: BRENDA L DOUGHERTY
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED., BCBA
Phone: 267-642-4039