Healthcare Provider Details

I. General information

NPI: 1831023381
Provider Name (Legal Business Name): GOLDEN MOON ABA VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

701 E FRANKLIN ST
RICHMOND VA
23219-2512
US

IV. Provider business mailing address

301 MILL RD
HEWLETT NY
11557-1291
US

V. Phone/Fax

Practice location:
  • Phone: 917-494-0666
  • Fax:
Mailing address:
  • Phone:
  • 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: MR. MARC JACOBOWITZ
Title or Position: CEO
Credential:
Phone: 917-494-0666