Cor Behavioral Group LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-08-4116 Issued in NJ

Legal business name

COR BEHAVIORAL GROUP LLC

Practice address

601 Flaghouse Dr
Hasbrouck Heights, NJ 07604-3118

Phone

(201) 660-8270

Fax

(201) 660-8271

NPI assigned

Jul 2, 2014

Organization subpart

No

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

Authorized official

Name

Kimberly Mitchell Potter, BCBA LBA

Title

Chief Clinical Officer

Phone

(201) 660-8270

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1404259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603670400000",
    "number": "1346656006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 FLAGHOUSE DR",
            "city": "HASBROUCK HEIGHTS",
            "state": "NJ",
            "postal_code": "076043118",
            "telephone_number": "201-660-8270",
            "fax_number": "800-985-9749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 FLAGHOUSE DR",
            "city": "HASBROUCK HEIGHTS",
            "state": "NJ",
            "postal_code": "076043118",
            "telephone_number": "201-660-8270",
            "fax_number": "201-660-8271"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "148 Main St Ste C1",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "NJ",
            "postal_code": "088332157",
            "country_code": "US",
            "telephone_number": "833-426-7222",
            "fax_number": "201-660-8271",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COR BEHAVIORAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-02",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "MITCHELL",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "201-660-8270",
        "authorized_official_credential": "BCBA LBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "NJ",
            "license": "1-08-4116",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; 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.