Provider Demographics
NPI:1487317137
Name:BOBERICK ABA SERVICES LLC
Entity type:Organization
Organization Name:BOBERICK ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:
Authorized Official - First Name:XXXX
Authorized Official - Middle Name:
Authorized Official - Last Name:XXXXX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:111-111-1111
Mailing Address - Street 1:7-24 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7-24 PARK AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1706
Practice Address - Country:US
Practice Address - Phone:908-421-5801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-20
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty