Healthcare Provider Details

I. General information

NPI: 1720771959
Provider Name (Legal Business Name): MY TEAM ABA GA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OLD ROSWELL LAKES PKWY STE 310
ROSWELL GA
30076-8667
US

IV. Provider business mailing address

158 LATCHES LN
BALA CYNWYD PA
19004-3015
US

V. Phone/Fax

Practice location:
  • Phone: 610-952-8628
  • Fax:
Mailing address:
  • Phone: 610-952-8628
  • Fax: 215-618-2509

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

VIII. Authorized Official

Name: RITA SCHWARTZ
Title or Position: OWNER
Credential:
Phone: 610-952-8628