Healthcare Provider Details

I. General information

NPI: 1194680686
Provider Name (Legal Business Name): ANGELCARE ABA THERAPY NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 AMERICA AVE UNIT 306
LAKEWOOD NJ
08701-4582
US

IV. Provider business mailing address

15 AMERICA AVE UNIT 306
LAKEWOOD NJ
08701-4582
US

V. Phone/Fax

Practice location:
  • Phone: 215-610-5505
  • Fax: 844-440-2323
Mailing address:
  • Phone: 215-610-5505
  • Fax: 844-440-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BLIMA BREZEL
Title or Position: DIRECTOR
Credential:
Phone: 215-610-5505