Healthcare Provider Details

I. General information

NPI: 1003194184
Provider Name (Legal Business Name): BEHAVIOR ANALYSIS & THERAPEUTIC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2011
Last Update Date: 07/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 W MAIN ST
SPRING GLEN PA
17978-9548
US

IV. Provider business mailing address

600 LYTLE ST
MINERSVILLE PA
17954-1813
US

V. Phone/Fax

Practice location:
  • Phone: 570-691-6726
  • Fax:
Mailing address:
  • Phone: 570-691-6726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015109
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1096458
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BERNADINE SANTAI MCNAMARA
Title or Position: PRESIDENT
Credential: LCSW
Phone: 570-691-6726