MEDICARE: CULTURE ABA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1063146504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CULTURE ABA LLC

Provider Business Mailing Address
First Line	:	4107 MITSCHER CT
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-1307
Country	:	US
Telephone Number	:	401-808-5067
Fax Number	:

Provider Business Practice Location Address
First Line	:	4107 MITSCHER CT
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-1307
Country	:	US
Telephone Number	:	401-808-5067
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	TOYIN T SHEKONI
Credential	:	M.S, BCBA, LBA
Telephone Number	:	401-808-5067

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	07/11/2022

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