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General NPI Number Information
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NPI Number | 1639787393
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Entity Type | Organization
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Legal Business Name | SKY CARE ABA LLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 41 CARASALJO DRIVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701
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Country | US
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Telephone | 732-243-8196
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Fax |
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Provider Business Mailing Address
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Address Line | 41 CARASALJO DRIVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701
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Country | US
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Telephone | 732-243-8196
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING/CONTRACTING
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Name | DIANA K FUNK
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Credential |
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Telephone | 949-422-3609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #6
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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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