Healthcare Provider Details

I. General information

NPI: 1922945161
Provider Name (Legal Business Name): BLUEBELL ABA THERAPY MARYLAND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PRATT ST
BALTIMORE MD
21202-3116
US

IV. Provider business mailing address

18 COX CRO RD
TOMS RIVER NJ
08755-0938
US

V. Phone/Fax

Practice location:
  • Phone: 704-610-7500
  • Fax:
Mailing address:
  • Phone: 704-610-7500
  • 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: AVI RICHMAN
Title or Position: DIRECTOR
Credential:
Phone: 704-610-7500