| Xanadu Behavior Therapy | |
|
615 Lacey Rd Suite 3 Forked River NJ 08731-2200 | |
| (609) 242-3322 | |
| (609) 242-3333 |
| Full Name | Xanadu Behavior Therapy |
|---|---|
| Speciality | Behavior Analyst |
| Location | 615 Lacey Rd, Forked River, New Jersey |
| Authorized Official Name and Position | Stacie Groeling (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6092423322 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Xanadu Behavior Therapy 615 Lacey Rd Suite 3 Forked River NJ 08731-2200 Ph: (609) 242-3322 | Xanadu Behavior Therapy 615 Lacey Rd Suite 3 Forked River NJ 08731-2200 Ph: (609) 242-3322 |
| NPI Number | 1992933634 |
|---|---|
| Provider Enumeration Date | 07/01/2009 |
| Last Update Date | 02/25/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992933634 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | 0-06-2178 (New Jersey) | Primary |
| 104100000X | Social Worker | 44SL04976200 (New Jersey) | Secondary |
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