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General NPI Number Information
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NPI Number | 1669215638
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Entity Type | Organization
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Legal Business Name | ABA BRIGHTSIDE IN LLC
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 8720 KNICKERBOCKER WAY
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-2102
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Country | US
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Telephone | 347-461-0983
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Fax |
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Provider Business Mailing Address
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Address Line | 46 WASHINGTON AVE STE 1
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City | SUFFERN
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State | NY
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Zip | 10901-5608
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Country | US
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Telephone | 347-461-0983
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Fax |
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Authorized Official
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Title or Position | VP OF OPERATIONS
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Name | MAYER KULEFSKY
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Credential |
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Telephone | 347-461-0983
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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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