Organization
KAMALATHARA SRIKANTH
Active
Other names
none
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAMALATHARA SRIKANTH MAT, BCBA (CLINICAL DIRECTOR)
(609) 721-2227
Entity
Organization
Contact information
Practice address
12 VAN GOGH DR, EAST WINDSOR, NJ 08520-2999
(609) 721-2227
Mailing address
12 VAN GOGH DR, EAST WINDSOR, NJ 08520-2999
(609) 721-2227
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1-10-7089
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396046157
NPI
NJ
Enumeration date
06/05/2012
Last updated
06/05/2012
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