Healthcare Provider Details

I. General information

NPI: 1114626884
Provider Name (Legal Business Name): ABA FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LINDEN AVE
STANHOPE NJ
07874-2638
US

IV. Provider business mailing address

6 LINDEN AVE
STANHOPE NJ
07874-2638
US

V. Phone/Fax

Practice location:
  • Phone: 718-775-0110
  • Fax:
Mailing address:
  • Phone: 718-775-0110
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CARLOS ALEXANDER CORDOVA
Title or Position: DIRECTOR
Credential:
Phone: 718-775-0110