Healthcare Provider Details

I. General information

NPI: 1912565516
Provider Name (Legal Business Name): FUNCTIONAL CONNECTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 PATLA RD
SWEET VALLEY PA
18656-2218
US

IV. Provider business mailing address

448 PATLA RD
SWEET VALLEY PA
18656-2218
US

V. Phone/Fax

Practice location:
  • Phone: 570-550-0778
  • Fax:
Mailing address:
  • Phone: 570-550-0778
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE JEAN JONES
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, BCBA, BSL
Phone: 570-550-0778