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General NPI Number Information
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NPI Number | 1013496264
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Entity Type | Organization
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Legal Business Name | INTENTIONAL INTERVENTIONS, LLC
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 1501 S NEW RD
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City | PLEASANTVILLE
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State | NJ
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Zip | 08232-3765
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Country | US
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Telephone | 609-380-1122
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Fax | 609-374-9166
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Provider Business Mailing Address
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Address Line | 125 DELAWARE AVE
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City | EGG HARBOR TOWNSHIP
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State | NJ
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Zip | 08234-5796
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Country | US
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Telephone | 609-402-2720
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Fax | 609-788-3617
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MS. TALIA STEPHENS
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Credential | BCBA
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Telephone | 609-402-2720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-30938
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License Number State |
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