Healthcare Provider Details

I. General information

NPI: 1124733688
Provider Name (Legal Business Name): BRIGHT START ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 POST OFFICE RD STE M
WALDORF MD
20602-2744
US

IV. Provider business mailing address

9310 ROLLINGWOOD DR
POMFRET MD
20675-3125
US

V. Phone/Fax

Practice location:
  • Phone: 504-289-3597
  • Fax:
Mailing address:
  • Phone: 504-289-3597
  • 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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. OMAR JUDEH
Title or Position: FOUNDER
Credential:
Phone: 504-289-3597