Healthcare Provider Details

I. General information

NPI: 1609604032
Provider Name (Legal Business Name): STORYBOOK ABA VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 RESTON METRO PLZ
RESTON VA
20190-5218
US

IV. Provider business mailing address

184 TUDOR CT
LAKEWOOD NJ
08701-1471
US

V. Phone/Fax

Practice location:
  • Phone: 718-564-4188
  • Fax:
Mailing address:
  • Phone: 718-564-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHAYIM ROSENBERG
Title or Position: FOUNDER
Credential:
Phone: 718-564-4188