Healthcare Provider Details

I. General information

NPI: 1881476646
Provider Name (Legal Business Name): ABA MAGICAL MOMENTS AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15150 W PARK PL FL 2
GOODYEAR AZ
85395-2385
US

IV. Provider business mailing address

300 TICE BLVD STE 165
WOODCLIFF LAKE NJ
07677-8405
US

V. Phone/Fax

Practice location:
  • Phone: 928-224-2610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JACOB KLEIN
Title or Position: OWNER
Credential:
Phone: 317-648-9509