MEDICARE: BRIGHTER STRIDES ABA GA 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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1134798697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTER STRIDES ABA GA LLC

Provider Business Mailing Address
First Line	:	3600 ROUTE 66 STE 150
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-2645
Country	:	US
Telephone Number	:	410-609-6357
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2177
Country	:	US
Telephone Number	:	410-609-6357
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABE WOLMARK
Credential	:
Telephone Number	:	410-609-6357

Provider Enumeration Date	:	06/20/2021
Last Update Date	:	06/20/2021

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