Healthcare Provider Details

I. General information

NPI: 1265343602
Provider Name (Legal Business Name): CRYSTALCARE ABA OH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 MARKET AVE N STE 100
CANTON OH
44721-2430
US

IV. Provider business mailing address

23 KING DAVID DR
LAKEWOOD NJ
08701-4666
US

V. Phone/Fax

Practice location:
  • Phone: 732-609-7624
  • Fax:
Mailing address:
  • Phone: 732-609-7624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ESTHER ELLINSON
Title or Position: CLINICAL DIRECTOR
Credential: MS ED BCBA LBA
Phone: 732-609-7624