=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700690930
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYMPHONY ABA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2025
-----------------------------------------------------
Last Update Date | 02/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3900 WESTERRE PKWY
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23233-1478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-549-9739
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2348 VERMONT AVE
-----------------------------------------------------
City | TOMS RIVER
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08755-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-549-9739
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSEPH UNGAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 917-549-9739
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------