Healthcare Provider Details

I. General information

NPI: 1447061619
Provider Name (Legal Business Name): BRAVE HEARTS ABA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 S ROUTE 9W STE 208
WEST HAVERSTRAW NY
10993-1053
US

IV. Provider business mailing address

45 S ROUTE 9W STE 208
WEST HAVERSTRAW NY
10993-1053
US

V. Phone/Fax

Practice location:
  • Phone: 845-499-9121
  • Fax:
Mailing address:
  • Phone:
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER ZOLA
Title or Position: DIRECTOR
Credential:
Phone: 845-499-9121