Healthcare Provider Details

I. General information

NPI: 1437096732
Provider Name (Legal Business Name): ABIGAIL JOY LICHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 TANGLEWOOD LN BAY VILLAGE
BAY VILLAGE OH
44140-1130
US

IV. Provider business mailing address

5255 HAUSERMAN RD APT 4
CLEVELAND OH
44130-1231
US

V. Phone/Fax

Practice location:
  • Phone: 440-668-5342
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: