Healthcare Provider Details

I. General information

NPI: 1225674740
Provider Name (Legal Business Name): PRIME ABA CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ASH ST
SCRANTON PA
18510-1546
US

IV. Provider business mailing address

2000 ASH ST
SCRANTON PA
18510-1546
US

V. Phone/Fax

Practice location:
  • Phone: 570-871-4751
  • Fax: 570-955-5323
Mailing address:
  • Phone: 570-871-4751
  • Fax: 570-955-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

# 1
Identifier103589790
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: PERLA EDITH GOLDSTEIN
Title or Position: OWNER/DIRECTOR
Credential: LBS., BCBA., LBA
Phone: 570-871-4751