Provider Demographics
NPI:1447816574
Name:AJA PLUS THERAPY FOR KIDS
Entity type:Organization
Organization Name:AJA PLUS THERAPY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:917-754-9228
Mailing Address - Street 1:371 BADEN PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-6044
Mailing Address - Country:US
Mailing Address - Phone:917-754-9228
Mailing Address - Fax:
Practice Address - Street 1:371 BADEN PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-6044
Practice Address - Country:US
Practice Address - Phone:917-754-9228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty