Healthcare Provider Details

I. General information

NPI: 1457031908
Provider Name (Legal Business Name): ACHIEVE ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 OCEAN AVE
BROOKLYN NY
11229-2303
US

IV. Provider business mailing address

2241 OCEAN AVE
BROOKLYN NY
11229-2303
US

V. Phone/Fax

Practice location:
  • Phone: 917-359-2111
  • Fax: 718-504-3983
Mailing address:
  • Phone: 917-359-2111
  • Fax: 718-504-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: FLORA LAX
Title or Position: MANAGING MEMBER
Credential:
Phone: 917-359-2111