Provider Demographics
NPI:1679979736
Name:A AND J BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:A AND J BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ABA THERIPST
Authorized Official - Prefix:
Authorized Official - First Name:TIVA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSHFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-560-7355
Mailing Address - Street 1:8 HALFCIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1330
Mailing Address - Country:US
Mailing Address - Phone:631-560-7355
Mailing Address - Fax:
Practice Address - Street 1:8 HALFCIRCLE DR
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1330
Practice Address - Country:US
Practice Address - Phone:631-560-7355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health