Organization
XANADU BEHAVIOR THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STACIE GROELING (EXECUTIVE DIRECTOR)
(609) 242-3322
Entity
Organization
Contact information
Practice address
615 LACEY RD, SUITE 3, FORKED RIVER, NJ 08731-2200
(609) 242-3322
(609) 242-3333
Mailing address
615 LACEY RD, SUITE 3, FORKED RIVER, NJ 08731-2200
(609) 242-3322
(609) 242-3333
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0-06-2178
NJ
104100000X
Social Worker
44SL04976200
NJ
Other
Enumeration date
07/01/2009
Last updated
02/25/2013
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