Provider Demographics
NPI:1710219696
Name:THE DATA GROUP-DESIGNING ACTIVITIES & TREATMENTS IN AUTISM
Entity type:Organization
Organization Name:THE DATA GROUP-DESIGNING ACTIVITIES & TREATMENTS IN AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:732-533-7088
Mailing Address - Street 1:28 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07933-1405
Mailing Address - Country:US
Mailing Address - Phone:732-533-7088
Mailing Address - Fax:
Practice Address - Street 1:28 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:NJ
Practice Address - Zip Code:07933-1405
Practice Address - Country:US
Practice Address - Phone:732-533-7088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health