Autism Behavioral Wellness LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

AUTISM BEHAVIORAL WELLNESS LLC

Practice address

222 12TH St SE
DC, WA 20003

Phone

(732) 239-2874

NPI assigned

Oct 25, 2022

Last updated

Oct 25, 2022By 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

David Justin Berg

Title

Principal

Phone

(732) 239-2874

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1144947615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4345 US HIGHWAY 9 #1025",
            "address_2": "STE 7",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "07728",
            "telephone_number": "732-239-2874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 12TH ST SE",
            "city": "DC",
            "state": "WA",
            "postal_code": "20003",
            "telephone_number": "732-239-2874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM BEHAVIORAL WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "JUSTIN",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "732-239-2874"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.