Healthcare Provider Details

I. General information

NPI: 1063051407
Provider Name (Legal Business Name): GOLDEN STEPS ABA VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 CLAIBORNE SQ E STE 334
HAMPTON VA
23666-2074
US

IV. Provider business mailing address

600 3RD AVE FL 2
NEW YORK NY
10016-1919
US

V. Phone/Fax

Practice location:
  • Phone: 615-570-9959
  • Fax: 646-859-4440
Mailing address:
  • Phone: 845-596-5130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: YISROEL WOLMARK
Title or Position: CEO
Credential:
Phone: 845-596-5130