Provider Demographics
NPI:1144947615
Name:AUTISM BEHAVIORAL WELLNESS LLC
Entity type:Organization
Organization Name:AUTISM BEHAVIORAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-239-2874
Mailing Address - Street 1:4345 US HIGHWAY 9 #1025
Mailing Address - Street 2:STE 7
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-239-2874
Mailing Address - Fax:
Practice Address - Street 1:222 12TH ST SE
Practice Address - Street 2:
Practice Address - City:DC
Practice Address - State:WA
Practice Address - Zip Code:20003
Practice Address - Country:US
Practice Address - Phone:732-239-2874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health