=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730815622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLIED BEHAVIORAL SERVICES MASON, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2022
-----------------------------------------------------
Last Update Date | 04/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7413 SQUIRE CT
-----------------------------------------------------
City | WEST CHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45069-2313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-847-4685
-----------------------------------------------------
Fax | 513-847-4763
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 VILLAGE SQ STE 210
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21210-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-525-4271
-----------------------------------------------------
Fax | 410-415-5188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PAYOE ENROLLMENT & CONTRACTING
-----------------------------------------------------
Name | DEENA STEIN GREENBLATT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-525-4271
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------