Tidal Behavioral ABA NJ LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

TIDAL BEHAVIORAL ABA NJ LLC

Doing business as

Tidal Behavioral ABA NJ LLC

Practice address

820 Bear Tavern Rd
Ewing, NJ 08628-1021

Phone

(718) 736-5689

NPI assigned

Feb 12, 2024

Last updated

Feb 12, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jack Elias

Title

Controller

Phone

(171) 873-6568

Specialties & licenses 1

Addresses

Other names 1

• Tidal Behavioral ABA NJ LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1023872975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 STERLING PL",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115592414",
            "telephone_number": "171-873-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 BEAR TAVERN RD",
            "city": "EWING",
            "state": "NJ",
            "postal_code": "086281021",
            "telephone_number": "718-736-5689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDAL BEHAVIORAL ABA NJ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "ELIAS",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "171-873-6568"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tidal Behavioral ABA NJ LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shontel Thomas, LSW
• Casey Ann Thompson, APN
• Lucas Thompson, LPC
• Thrivepath Mental Health Services
• Tidal ABA NJ LLC
• Christina M Tierney, LCADC
• Polina Tilei, LSW
• Herwin Torres, LSW
• Jesse Totoro, MS, ATC
• Miyonne Toussaint

• Community/Behavioral Health Agency in Ewing, NJ
• Providers in Ewing, NJ by specialty
• Community/Behavioral Health Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.