Provider Demographics
NPI:1922839364
Name:JERSEY SHORE BEHAVIORAL THERAPY LLC
Entity type:Organization
Organization Name:JERSEY SHORE BEHAVIORAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CAVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:609-772-2918
Mailing Address - Street 1:1069 BELL ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3776
Mailing Address - Country:US
Mailing Address - Phone:609-772-2918
Mailing Address - Fax:
Practice Address - Street 1:1069 BELL ST
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3776
Practice Address - Country:US
Practice Address - Phone:609-772-2918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty