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General NPI Number Information
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NPI Number | 1770068587
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Entity Type | Organization
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Legal Business Name | MAIN LINE BEHAVIOR SERVICES
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 523 N BROAD ST APT 503
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4149
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Country | US
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Telephone | 215-995-1850
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Fax |
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Provider Business Mailing Address
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Address Line | 523 N BROAD ST APT 503
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City | PHILADELPHIA
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State | PA
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Zip | 19123-4149
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Country | US
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Telephone | 215-995-1850
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Fax |
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Authorized Official
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Title or Position | OWNER AND DIRECTOR
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Name | JESSICA BALDWIN
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Credential |
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Telephone | 215-995-1850
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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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