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General NPI Number Information
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NPI Number | 1992299820
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Entity Type | Organization
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Legal Business Name | SMJ BEHAVIORAL CONSULTANTS LLC
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 503 S 61ST ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1012
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Country | US
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Telephone | 215-300-0691
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Fax |
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Provider Business Mailing Address
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Address Line | 503 S 61ST ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1012
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Country | US
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Telephone | 215-300-0691
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Fax |
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Authorized Official
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Title or Position | LICENSED BEHAVIOR SPECIALIST
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Name | SHERITA JAMISON
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Credential | MSW
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Telephone | 215-300-0691
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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 | BH001312
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License Number State | PA
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