Healthcare Provider Details

I. General information

NPI: 1346858214
Provider Name (Legal Business Name): JOURNEY ABA NE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST STE 200
CHARLESTOWN MA
02129-1119
US

IV. Provider business mailing address

5801 SW 37TH TER
FORT LAUDERDALE FL
33312-6230
US

V. Phone/Fax

Practice location:
  • Phone: 617-910-1414
  • Fax: 617-910-1415
Mailing address:
  • Phone: 612-817-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID A KUTOFF
Title or Position: PRESIDENT
Credential:
Phone: 612-817-0388