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General NPI Number Information
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NPI Number | 1518571108
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Entity Type | Organization
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Legal Business Name | NEW BEHAVIOR TRANSITIONS
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 1154 E 36TH ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-1812
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Country | US
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Telephone | 909-918-7223
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Fax |
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Provider Business Mailing Address
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Address Line | 1154 E 36TH ST
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-1812
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Country | US
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Telephone | 909-918-7223
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Fax |
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Authorized Official
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Title or Position | CLINICAL COORDINATOR
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Name | SHANTA DORSEY
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Credential | MA, BCBA
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Telephone | 909-918-7223
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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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