Healthcare Provider Details

I. General information

NPI: 1447169404
Provider Name (Legal Business Name): ALL STAR ABA NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 REISTERSTOWN RD STE 112
BALTIMORE MD
21208-1317
US

IV. Provider business mailing address

1777 REISTERSTOWN RD STE 112
BALTIMORE MD
21208-1317
US

V. Phone/Fax

Practice location:
  • Phone: 410-541-1316
  • Fax:
Mailing address:
  • Phone: 410-541-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAWN TYBERG
Title or Position: DIRECTOR
Credential:
Phone: 718-600-6604