Healthcare Provider Details

I. General information

NPI: 1790543973
Provider Name (Legal Business Name): GREENLIGHT ABA AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 E SPEEDWAY BLVD STE 401
TUCSON AZ
85710-1220
US

IV. Provider business mailing address

6700 E SPEEDWAY BLVD STE 401
TUCSON AZ
85710-1220
US

V. Phone/Fax

Practice location:
  • Phone: 877-881-3090
  • 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
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DOV FRIEDMAN
Title or Position: COO
Credential:
Phone: 718-614-9823