Provider Demographics
NPI:1285331868
Name:CHARTER BEHAVIOR MANAGEMENT PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:CHARTER BEHAVIOR MANAGEMENT PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNER EL
Authorized Official - Suffix:
Authorized Official - Credentials:MED BCBA LBS
Authorized Official - Phone:215-510-8841
Mailing Address - Street 1:185 W CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2223
Mailing Address - Country:US
Mailing Address - Phone:215-510-8841
Mailing Address - Fax:
Practice Address - Street 1:254 CHAPMAN RD STE 112
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5413
Practice Address - Country:US
Practice Address - Phone:215-510-8841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty