MEDICARE: MASTER IT BEHAVIOR THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	235Z00000X	Speech-Language Pathologist
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1730770611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASTER IT BEHAVIOR THERAPY LLC

Provider Business Mailing Address
First Line	:	209 ELAINE ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 ELAINE ST
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5012
Country	:	US
Telephone Number	:	732-538-4458
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARA ZISKIND
Credential	:	MA BCBA
Telephone Number	:	732-538-4458

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/02/2021

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