Supreme Behavioral Therapy LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

SUPREME BEHAVIORAL THERAPY LLC

Practice address

211 Boulevard of the Americas
Suite 105
Lakewood, NJ 08701

Phone

(732) 598-1235

NPI assigned

May 14, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Elliott Birnbaum

Title

Manager

Phone

(732) 598-1235

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1715644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1437908423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 BOULEVARD OF THE AMERICAS",
            "address_2": "SUITE 105",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "08701",
            "telephone_number": "732-598-1235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 BOULEVARD OF THE AMERICAS",
            "address_2": "SUITE 105",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "08701",
            "telephone_number": "732-598-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME BEHAVIORAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-14",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-06",
        "status": "A",
        "authorized_official_last_name": "BIRNBAUM",
        "authorized_official_first_name": "ELLIOTT",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "732-598-1235",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Lakewood, NJ
• Providers in Lakewood, NJ by specialty
• Behavior Analyst in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 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.