Healthcare Provider Details

I. General information

NPI: 1114450400
Provider Name (Legal Business Name): ABA THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PLAZA DR
POCONO SUMMIT PA
18346-7844
US

IV. Provider business mailing address

6506 RUNNYMEAD LN
TOBYHANNA PA
18466-3252
US

V. Phone/Fax

Practice location:
  • Phone: 570-216-3900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH001527
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. BETH L RAIOLA
Title or Position: DIRECTOR
Credential: BCBA
Phone: 570-216-3900