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General NPI Number Information
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NPI Number | 1083412928
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Entity Type | Organization
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Legal Business Name | NEUROSPROUT ABA MD LLC
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1777 REISTERSTOWN RD STE 290
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City | BALTIMORE
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State | MD
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Zip | 21208-1390
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Country | US
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Telephone | 213-332-8893
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Fax |
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Provider Business Mailing Address
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Address Line | 1241 EDRIS DR
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City | LOS ANGELES
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State | CA
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Zip | 90035-1113
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Country | US
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Telephone | 213-332-8893
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | ISSAC COHEN
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Credential |
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Telephone | 213-000-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 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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