MEDICARE: GUIDED GROWTH ABA NY 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	:	1477360295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDED GROWTH ABA NY LLC

Provider Business Mailing Address
First Line	:	1651 E 23RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1518
Country	:	US
Telephone Number	:	323-241-2919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 E 23RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1518
Country	:	US
Telephone Number	:	323-241-2919
Fax Number	:

Authorized Official
Title or Position	:	BACB
Name	:	MRS. SORA FAIGA ENOCK
Credential	:
Telephone Number	:	732-674-9863

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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Directions to “GUIDED GROWTH ABA NY LLC ” Practice Location

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