NPIMap

Organization Active NPI

Monmouth Behavioral Therapy Group, LLC

  • Behavior Analyst
  • Red Bank, NJ
National Provider Identifier
1508179763
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
0400352192 Issued in NJ
Legal business name
MONMOUTH BEHAVIORAL THERAPY GROUP, LLC
Practice address
43 W Front St Ste 17
Red Bank, NJ 07701-1600
Phone
(732) 784-7501
Fax
(732) 383-5844
NPI assigned
Jul 16, 2010
Last updated
Apr 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Authorized official

Name
Anna Nicolas
Title
Owner
Phone
(732) 687-2418

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 0400352192 NJ Primary

Addresses

Primary practice location

43 W Front St Ste 17
Red Bank, NJ 07701-1600

Mailing address

54 Broad St # L-102
Red Bank, NJ 07701-1943
Phone (732) 687-2418

Other practice location 1

1000 Sanger Ave
Oceanport, NJ 07757-1241
Phone (732) 687-2418

Other identifiers 1

IdentifierTypeStateIssuer
0400352192OtherNJSTATE OF NEW JERSEY DEPT. OF THE TREASURY CERTIFICATION

Other names 1

  • aBA with TLC Other name

National Provider Directory

National Provider Directory
Tax ID family
Monmouth Behavioral Therapy Group LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1000 Sanger Ave
Oceanport, NJ 07757
Phone (732) 687-2418

43 W Front St
Ste 17
Red Bank, NJ 07701
Phone (732) 784-7501

54 Broad St
#L102
Red Bank, NJ 07701

NPI Registry JSON

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

{
    "created_epoch": "1279238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1508179763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 BROAD ST # L-102",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077011943",
            "telephone_number": "732-687-2418",
            "fax_number": "732-383-5844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 W FRONT ST STE 17",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077011600",
            "telephone_number": "732-784-7501",
            "fax_number": "732-383-5844"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Sanger Ave",
            "address_purpose": "LOCATION",
            "city": "Oceanport",
            "state": "NJ",
            "postal_code": "077571241",
            "country_code": "US",
            "telephone_number": "732-687-2418",
            "fax_number": "732-865-7187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MONMOUTH BEHAVIORAL THERAPY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-16",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A",
        "authorized_official_last_name": "NICOLAS",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-687-2418"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NJ",
            "license": "0400352192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF NEW JERSEY DEPT. OF THE TREASURY CERTIFICATION",
            "identifier": "0400352192",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "aBA with TLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "aBA with TLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Red Bank, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2023; 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.