Healthcare Provider Details

I. General information

NPI: 1922683432
Provider Name (Legal Business Name): LOTUS ABA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 09/11/2025
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 ROUTE 130 N STE J
CINNAMINSON NJ
08077-3032
US

IV. Provider business mailing address

1104 ROUTE 130 N STE J
CINNAMINSON NJ
08077-3032
US

V. Phone/Fax

Practice location:
  • Phone: 856-381-4622
  • Fax: 856-389-5475
Mailing address:
  • Phone: 856-381-4622
  • 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: TARA L. MILLER
Title or Position: OWNER
Credential: BCBA
Phone: 856-381-4622