Healthcare Provider Details

I. General information

NPI: 1922633791
Provider Name (Legal Business Name): MAGICAL STEPS ABA FL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 COLLINS AVE APT 801
MIAMI BEACH FL
33140-3216
US

IV. Provider business mailing address

150 OBERLIN AVE N STE 6
LAKEWOOD NJ
08701-4535
US

V. Phone/Fax

Practice location:
  • Phone: 610-908-6690
  • Fax:
Mailing address:
  • Phone: 732-978-4040
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSH WEINBERGER
Title or Position: MEMBER
Credential:
Phone: 732-978-4040