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General NPI Number Information
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NPI Number | 1609129121
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Entity Type | Organization
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Legal Business Name | SPECTRUM ABA SERVICES LLC
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 11/11/2014
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Provider Practice Location Address
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Address Line | 857 DARLINGTON AVE
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City | MAHWAH
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State | NJ
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Zip | 07430-2528
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Country | US
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Telephone | 201-500-5484
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Fax |
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Provider Business Mailing Address
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Address Line | 12 E RAMAPO AVE #842
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City | MAHWAH
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State | NJ
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Zip | 07430-7000
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Country | US
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Telephone | 201-500-5484
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER, BUSINESS DIRECTOR
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Name | MRS. LAUREN BESWICK
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Credential |
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Telephone | 201-500-5484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-09-5649
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License Number State | NJ
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