Healthcare Provider Details

I. General information

NPI: 1124783972
Provider Name (Legal Business Name): ENVIRONMENTAL BEHAVIOR SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2021
Last Update Date: 04/09/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10692 LEONARD CORDOVA RD
RENICK WV
24966-7256
US

IV. Provider business mailing address

10692 LEONARD CORDOVA RD
RENICK WV
24966-7256
US

V. Phone/Fax

Practice location:
  • Phone: 330-565-3386
  • Fax:
Mailing address:
  • Phone: 330-565-3386
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER C CAMMARATA
Title or Position: SUPERVISOR
Credential: BCBA
Phone: 330-565-3386