Provider Demographics
NPI:1487927661
Name:THE BEDROCK CLINIC
Entity type:Organization
Organization Name:THE BEDROCK CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:646-377-2109
Mailing Address - Street 1:347 PLAINFIELD AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3163
Mailing Address - Country:US
Mailing Address - Phone:646-377-2109
Mailing Address - Fax:
Practice Address - Street 1:347 PLAINFIELD AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3163
Practice Address - Country:US
Practice Address - Phone:646-377-2109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-09-6595103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty