Healthcare Provider Details

I. General information

NPI: 1801634233
Provider Name (Legal Business Name): KIWI KIDS ABA NM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12611 MONTGOMERY BLVD NE STE A6B
ALBUQUERQUE NM
87111-4118
US

IV. Provider business mailing address

2302 AVENUE N
BROOKLYN NY
11210-5117
US

V. Phone/Fax

Practice location:
  • Phone: 917-846-6193
  • Fax:
Mailing address:
  • Phone: 917-846-6193
  • 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 Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MORDECHAI CUKIER
Title or Position: OWNER
Credential:
Phone: 917-846-6193