Provider Demographics
NPI:1386391027
Name:ELITE BEHAVIOR THERAPY
Entity type:Organization
Organization Name:ELITE BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:347-374-0303
Mailing Address - Street 1:192 EMMANUEL DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4882
Mailing Address - Country:US
Mailing Address - Phone:347-374-0303
Mailing Address - Fax:
Practice Address - Street 1:192 EMMANUEL DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4882
Practice Address - Country:US
Practice Address - Phone:347-374-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty