Organization
MAIN LINE BEHAVIOR SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA BALDWIN (OWNER AND DIRECTOR)
(215) 995-1850
Entity
Organization
Contact information
Practice address
523 N BROAD ST APT 503, PHILADELPHIA, PA 19123-4149
(215) 995-1850
Mailing address
523 N BROAD ST APT 503, PHILADELPHIA, PA 19123-4149
(215) 995-1850
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528303898
NOT KNOWN
—
Enumeration date
09/27/2018
Last updated
09/27/2018
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