Healthcare Provider Details

I. General information

NPI: 1356023410
Provider Name (Legal Business Name): ABA SHAPING SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9918 AVENUE M
BROOKLYN NY
11236-5041
US

IV. Provider business mailing address

9918 AVENUE M
BROOKLYN NY
11236-5041
US

V. Phone/Fax

Practice location:
  • Phone: 929-551-8799
  • Fax:
Mailing address:
  • Phone: 929-551-8799
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARSHA D MCKENZIE
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: BCBA/LBA
Phone: 929-551-8799