Healthcare Provider Details

I. General information

NPI: 1669103958
Provider Name (Legal Business Name): NORTHERN STAR ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 HUDSON ROAD
TEANECK NJ
07666
US

IV. Provider business mailing address

1363 HUDSON ROAD
TEANECK NJ
07666
US

V. Phone/Fax

Practice location:
  • Phone: 917-774-5233
  • Fax:
Mailing address:
  • Phone: 917-774-5233
  • 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 Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANIELA GUTTMAN
Title or Position: BCBA
Credential:
Phone: 917-774-5233