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General NPI Number Information
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NPI Number | 1407112030
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Entity Type | Organization
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Legal Business Name | 123 ABA, LLC
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Dates
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Enumeration Date | 04/09/2012
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 25 E NORTHFIELD RD SUITE B
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4531
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Country | US
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Telephone | 201-259-0817
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Fax |
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Provider Business Mailing Address
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Address Line | 25 E NORTHFIELD RD SUITE B
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City | LIVINGSTON
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State | NJ
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Zip | 07039-4531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/ BCBA
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Name | BRIANNE LIVELLI
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Credential |
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Telephone | 201-259-0817
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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 | 1-08-4039
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License Number State | NJ
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