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General NPI Number Information
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NPI Number | 1659164358
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Entity Type | Organization
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Legal Business Name | NEUROSPROUT ABA MD LLC
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Dates
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Enumeration Date | 05/26/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 1301 YORK RD STE 800-1030
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City | LUTHERVILLE
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State | MD
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Zip | 21093-6035
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Country | US
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Telephone | 213-332-8893
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Fax |
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Provider Business Mailing Address
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Address Line | 8 KIELT WAY BSMT
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5097
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Country | US
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Telephone | 410-357-1180
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YITZCHAK SELEH
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Credential |
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Telephone | 213-333-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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