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General NPI Number Information
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NPI Number | 1083500490
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Entity Type | Organization
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Legal Business Name | GOLD HEART ABA MD LLC
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 5700 SMITH AVE UNIT 101
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City | BALTIMORE
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State | MD
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Zip | 21209-3610
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Country | US
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Telephone | 732-637-9359
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Fax | 732-719-5787
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Provider Business Mailing Address
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Address Line | 5700 SMITH AVE UNIT 101
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City | BALTIMORE
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State | MD
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Zip | 21209-3610
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Country | US
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Telephone | 732-637-9359
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Fax | 732-719-5787
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Authorized Official
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Title or Position | DIRECTOR
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Name | YEHOUSHUA TYBERG
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Credential |
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Telephone | 732-813-5603
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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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