Provider Demographics
NPI:1124466479
Name:BEHAVIORAL PEDIATRICS AND ABA THERAPY ASSOCIATES, LLC.
Entity type:Organization
Organization Name:BEHAVIORAL PEDIATRICS AND ABA THERAPY ASSOCIATES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:267-642-4039
Mailing Address - Street 1:1020 ANDERS RD
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:267-642-4039
Mailing Address - Fax:
Practice Address - Street 1:1571 SUMNEYTOWN PIKE
Practice Address - Street 2:FIRST FLOOR OFFICE
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-4854
Practice Address - Country:US
Practice Address - Phone:267-642-4039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency