Healthcare Provider Details

I. General information

NPI: 1699583310
Provider Name (Legal Business Name): MIND RISE ABA VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10249 HENDLEY RD
MANASSAS VA
20110-7913
US

IV. Provider business mailing address

701 WELLINGTON AVE
TOMS RIVER NJ
08757-1310
US

V. Phone/Fax

Practice location:
  • Phone: 732-677-4124
  • Fax:
Mailing address:
  • Phone: 732-677-4124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA HERTZ
Title or Position: OWNER
Credential:
Phone: 732-677-4124