Healthcare Provider Details

I. General information

NPI: 1609520469
Provider Name (Legal Business Name): NURTURE ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 FARNAM ST STE 300
OMAHA NE
68102-1857
US

IV. Provider business mailing address

1221 MADISON AVE
LAKEWOOD NJ
08701-1753
US

V. Phone/Fax

Practice location:
  • Phone: 402-989-3350
  • Fax:
Mailing address:
  • Phone: 732-810-5124
  • 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: MENACHEM ZAKS
Title or Position: PRINCIPAL
Credential:
Phone: 732-810-5124