Basic Information
| Provider Information | |||||||||
| NPI: | 1477150399 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIGHTY STRIDES BEHAVIOR SOLUTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 549 PINE ST APT 19 | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018512336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473564585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 549 PINE ST SUITE 19 | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018512336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473564585 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2020 | ||||||||
| LastUpdateDate: | 10/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAMDHANY | ||||||||
| AuthorizedOfficialFirstName: | JESSIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BCBA, LABA | ||||||||
| AuthorizedOfficialTelephone: | 3473564585 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MA, BCBA, LABA | ||||||||
| NPICertificationDate: | 10/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.