Healthcare Provider Details

I. General information

NPI: 1235056516
Provider Name (Legal Business Name): KIWI ABA OH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 TREMONT ST
BOSTON MA
02111-1208
US

IV. Provider business mailing address

2320 AVENUE M
BROOKLYN NY
11210-4541
US

V. Phone/Fax

Practice location:
  • Phone: 917-846-6193
  • Fax:
Mailing address:
  • Phone: 917-846-6193
  • 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: MORDY CUKIER
Title or Position: MANAGING PARTNER
Credential:
Phone: 917-846-6193