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General NPI Number Information
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NPI Number | 1710385323
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Entity Type | Organization
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Legal Business Name | THE GREGORY CENTER FOR APPLIED BEHAVIOR ANALYSIS
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 17 STARK ST
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City | PITTSTON
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State | PA
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Zip | 18640-2026
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Country | US
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Telephone | 570-335-0357
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Fax |
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Provider Business Mailing Address
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Address Line | 17 STARK ST
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City | PITTSTON
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State | PA
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Zip | 18640-2026
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Country | US
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Telephone | 570-335-0357
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JODI GREGORY
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Credential | BCBA, LBS
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Telephone | 570-335-0357
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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 | BH00047
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License Number State | PA
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