Healthcare Provider Details

I. General information

NPI: 1386437697
Provider Name (Legal Business Name): ABA SKILL BUILDERS WY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 DELL RANGE BLVD STE 200
CHEYENNE WY
82009-4942
US

IV. Provider business mailing address

7 PINE VALLEY RD
LAKEWOOD NJ
08701-5716
US

V. Phone/Fax

Practice location:
  • Phone: 323-975-9998
  • 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
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DANIEL DUBIN
Title or Position: MANAGER
Credential:
Phone: 323-975-9998