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General NPI Number Information
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NPI Number | 1114582418
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL LEARNING NETWORK - NEW HAMPSHIRE LLC
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Dates
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Enumeration Date | 05/02/2019
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 6 HAINES BROOK FARM LN
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City | GREENLAND
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State | NH
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Zip | 03840-2365
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Country | US
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Telephone | 310-993-4499
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Fax | 310-993-4134
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Provider Business Mailing Address
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Address Line | 5435 BALBOA BLVD STE 202
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City | ENCINO
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State | CA
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Zip | 91316-1570
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Country | US
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Telephone | 310-993-4499
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Fax | 310-993-4134
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. GREGORY ELSKY
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Credential | PSY.D.
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Telephone | 310-993-4499
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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 |
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License Number State |
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