Provider Demographics
NPI:1144987645
Name:MAINSTREAM ABA SUPPORT SERVICES
Entity type:Organization
Organization Name:MAINSTREAM ABA SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-373-0196
Mailing Address - Street 1:43 KINGSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3095
Mailing Address - Country:US
Mailing Address - Phone:732-363-7872
Mailing Address - Fax:
Practice Address - Street 1:43 KINGSFIELD DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3095
Practice Address - Country:US
Practice Address - Phone:732-363-7872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty