Healthcare Provider Details

I. General information

NPI: 1922824770
Provider Name (Legal Business Name): ACTIFY ABA THERAPY MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 SECURITY BLVD STE 100-1227
BALTIMORE MD
21207-5173
US

IV. Provider business mailing address

6340 SECURITY BLVD STE 100-1227
BALTIMORE MD
21207-5173
US

V. Phone/Fax

Practice location:
  • Phone: 410-929-0988
  • Fax: 410-204-1915
Mailing address:
  • Phone: 410-929-0988
  • Fax: 410-204-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: YISROEL GOLDBERG
Title or Position: DIRECTOR
Credential:
Phone: 410-929-0988