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General NPI Number Information
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NPI Number | 1558294728
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Entity Type | Organization
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Legal Business Name | PROUD MOMENTS ABA
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 4961 TESLA DR STE A-C
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City | BOWIE
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State | MD
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Zip | 20715-4405
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Country | US
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Telephone | 301-329-8155
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Fax |
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Provider Business Mailing Address
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Address Line | 7724 MAPLE AVE APT 14
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City | TAKOMA PARK
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State | MD
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Zip | 20912-5652
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Country | US
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Telephone | 240-956-9658
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL TECH
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Name | MARIELA R SAMUEL
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Credential |
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Telephone | 240-956-9658
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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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