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General NPI Number Information
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NPI Number | 1508179763
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Entity Type | Organization
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Legal Business Name | MONMOUTH BEHAVIORAL THERAPY GROUP, LLC
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 43 W FRONT ST STE 17
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City | RED BANK
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State | NJ
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Zip | 07701-1600
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Country | US
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Telephone | 732-784-7501
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Fax | 732-383-5844
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Provider Business Mailing Address
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Address Line | 54 BROAD ST # L-102
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City | RED BANK
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State | NJ
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Zip | 07701-1943
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Country | US
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Telephone | 732-687-2418
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Fax | 732-383-5844
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Authorized Official
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Title or Position | OWNER
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Name | ANNA NICOLAS
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Credential |
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Telephone | 732-687-2418
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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 | 0400352192
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License Number State | NJ
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