MEDICARE: IMAGINATION ABA THERAPY

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	251S00000X	Community/Behavioral Health Agency
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1811683394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMAGINATION ABA THERAPY

Provider Business Mailing Address
First Line	:	535 E COUNTY LINE RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1486
Country	:	US
Telephone Number	:	732-732-2058
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 E COUNTY LINE RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1486
Country	:	US
Telephone Number	:	732-732-2058
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHANINA NAKDIMEN
Credential	:	BCBA
Telephone Number	:	848-226-0925

Provider Enumeration Date	:	04/17/2023
Last Update Date	:	02/12/2026

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Directions to “IMAGINATION ABA THERAPY ” Practice Location

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