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General NPI Number Information
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NPI Number | 1932648086
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Entity Type | Organization
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Legal Business Name | BEHAVIOR ANALYSIS AND SUPPORT SERVICES
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 60 GRAND AVE STE 1
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-6583
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Country | US
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Telephone | 201-849-4565
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Fax | 844-364-3239
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Provider Business Mailing Address
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Address Line | 60 GRAND AVE STE 1
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-6583
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Country | US
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Telephone | 551-800-2441
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Fax | 844-364-3239
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | MYRNA BASSAM
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Credential | M.S., BCBA
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Telephone | 201-851-2471
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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 | 11314553
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License Number State | CA
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