Provider Demographics
NPI:1548811821
Name:FUNDAMENTAL DEVELOPMENT ABA, LLC
Entity type:Organization
Organization Name:FUNDAMENTAL DEVELOPMENT ABA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:732-690-4793
Mailing Address - Street 1:85 FOREST DR APT D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1173
Mailing Address - Country:US
Mailing Address - Phone:732-690-5793
Mailing Address - Fax:
Practice Address - Street 1:85 FOREST DR APT D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1173
Practice Address - Country:US
Practice Address - Phone:732-690-4793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty