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General NPI Number Information
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NPI Number | 1124733688
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Entity Type | Organization
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Legal Business Name | BRIGHT START ABA LLC
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 7 POST OFFICE RD STE M
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City | WALDORF
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State | MD
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Zip | 20602-2744
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Country | US
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Telephone | 504-289-3597
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Fax |
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Provider Business Mailing Address
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Address Line | 9310 ROLLINGWOOD DR
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City | POMFRET
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State | MD
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Zip | 20675-3125
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Country | US
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Telephone | 504-289-3597
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MR. OMAR JUDEH
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Credential |
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Telephone | 504-289-3597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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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