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General NPI Number Information
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NPI Number | 1063141174
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Entity Type | Organization
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Legal Business Name | HEARTLEAF ABA LLC
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 396 GRIFFIN RD UNIT 106
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City | BANGOR
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State | ME
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Zip | 04401-3023
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Country | US
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Telephone | 207-745-0750
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Fax |
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Provider Business Mailing Address
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Address Line | 396 GRIFFIN RD UNIT 106
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City | BANGOR
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State | ME
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Zip | 04401-3023
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Country | US
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Telephone | 207-745-0750
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Fax |
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Authorized Official
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Title or Position | NETWORK OPERATIONS DIRECTOR
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Name | JUDY SEALS
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Credential |
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Telephone | 207-573-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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