Healthcare Provider Details

I. General information

NPI: 1669306973
Provider Name (Legal Business Name): KENNEDY ABA GA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PEACHTREE ST NE
ATLANTA GA
30361-3503
US

IV. Provider business mailing address

8 SPRINGBROOK DR
JACKSON NJ
08527-4367
US

V. Phone/Fax

Practice location:
  • Phone: 888-360-6664
  • Fax:
Mailing address:
  • Phone: 888-360-6664
  • 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: YITZCHOK CZIMENT
Title or Position: MANAGING MEMBER
Credential:
Phone: 888-360-6664