Organization
PATHBOLD
Active
Other names
Path Bold
Organization subpart
No
Provider details
NPI number
Authorized official
LESLYN GARVIN (DIRECTOR)
(732) 631-4034
Entity
Organization
Contact information
Practice address
18 PROSPECT STREET, SOUTH ORANGE, NJ 07079
(973) 289-0655
Mailing address
18 PROSPECT ST, SOUTH ORANGE, NJ 07079-2267
(732) 631-4034
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261Q00000X
Clinic/Center
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
04/08/2025
Last updated
04/01/2026
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