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General NPI Number Information
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NPI Number | 1598571317
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Entity Type | Organization
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Legal Business Name | BLUE MOUNTAIN ABA LLC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 3410 N HIGH SCHOOL RD STE G
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City | INDIANAPOLIS
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State | IN
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Zip | 46224-1100
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Country | US
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Telephone | 516-427-9582
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 DINSMORE AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-4753
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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 | OPERATIONS
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Name | MALKA ROSENZWEIG
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Credential |
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Telephone | 518-275-9654
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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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