Provider Demographics
NPI:1174097547
Name:AWAKEN LICENSED APPLIED BEHAVIORAL ANALYSIS SERVICES PLLC
Entity type:Organization
Organization Name:AWAKEN LICENSED APPLIED BEHAVIORAL ANALYSIS SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PETAGAYE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA, LBA
Authorized Official - Phone:914-363-8313
Mailing Address - Street 1:8480 BALTIMORE NATIONAL PIKE STE 3210 #126
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:914-713-7974
Mailing Address - Fax:
Practice Address - Street 1:8480 BALTIMORE NATIONAL PIKE STE 3210 #126
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:914-713-7974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty