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General NPI Number Information
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NPI Number | 1316337223
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Entity Type | Organization
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Legal Business Name | SPECTRUM BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 01/29/2015
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 51 FIERRO AVE
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City | MATAWAN
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State | NJ
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Zip | 07747-3038
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Country | US
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Telephone | 732-788-5850
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Fax | 708-801-7211
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Provider Business Mailing Address
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Address Line | 51 FIERRO AVE
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City | MATAWAN
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State | NJ
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Zip | 07747-3038
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Country | US
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Telephone | 732-788-5850
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Fax | 708-801-7211
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN FOLEY
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Credential | BCBA
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Telephone | 732-788-5850
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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 | 1-08-4076
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License Number State | WA
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