MEDICARE: ITHRIVEABA 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	:	1174278832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITHRIVEABA LLC

Provider Business Mailing Address
First Line	:	10 PRIMROSE DR
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3283
Country	:	US
Telephone Number	:	848-525-2263
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 S JUNIPER ST STE 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-2703
Country	:	US
Telephone Number	:	215-399-5682
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JOSEPH SHEINFELD
Credential	:
Telephone Number	:	848-525-2263

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	08/01/2024

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