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General NPI Number Information
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NPI Number | 1225385529
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL ASSOCIATES
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 08/07/2012
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Provider Practice Location Address
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Address Line | 157 EAGLE ROCK AVE
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City | ROSELAND
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State | NJ
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Zip | 07068-1353
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Country | US
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Telephone | 973-226-8487
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Fax |
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Provider Business Mailing Address
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Address Line | 157 EAGLE ROCK AVE
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City | ROSELAND
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State | NJ
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Zip | 07068-1353
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Country | US
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Telephone | 973-226-8487
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Fax |
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Authorized Official
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Title or Position | OWNER PSYCHOLOGIST
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Name | DR. STEPHEN S CRAIG
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Credential | PH.D.
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Telephone | 973-226-8487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2601
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License Number State | NJ
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