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General NPI Number Information
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NPI Number | 1396644001
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Entity Type | Organization
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Legal Business Name | GOLDEN MOON ABA MA LLC
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 82 WENDELL AVE STE 100
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City | PITTSFIELD
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State | MA
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Zip | 01201
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Country | US
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Telephone | 917-538-8138
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Fax |
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Provider Business Mailing Address
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Address Line | 301 MILL RD
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City | HEWLETT
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State | NY
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Zip | 11557-1291
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Country | US
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Telephone | 917-538-8138
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARC JACOBOWITZ
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Credential |
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Telephone | 917-494-0666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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