Provider Demographics
NPI:1861917916
Name:SJ BEHAVIORAL SERVICES INC
Entity type:Organization
Organization Name:SJ BEHAVIORAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, MS ED
Authorized Official - Phone:347-582-0085
Mailing Address - Street 1:447 BEACH 126TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1722
Mailing Address - Country:US
Mailing Address - Phone:347-582-0085
Mailing Address - Fax:
Practice Address - Street 1:447 BEACH 126TH ST
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-1722
Practice Address - Country:US
Practice Address - Phone:347-582-0085
Practice Address - Fax:347-582-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty