Healthcare Provider Details

I. General information

NPI: 1881467215
Provider Name (Legal Business Name): A NEW LEAF ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BEACON STREET APT C-109
WORCESTER MA
01608
US

IV. Provider business mailing address

64 BEACON STREET APT C-109
WORCESTER MA
01608
US

V. Phone/Fax

Practice location:
  • Phone: 508-431-8366
  • Fax:
Mailing address:
  • Phone: 508-431-8366
  • 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: AMBER STICKLES
Title or Position: OWNER
Credential: BCBA, LABA
Phone: 508-431-8366