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General NPI Number Information
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NPI Number | 1841115086
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Entity Type | Organization
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Legal Business Name | ABODE ABA NM, LLC
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 500 4TH ST NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-5324
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Country | US
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Telephone | 980-360-1116
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Fax |
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Provider Business Mailing Address
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Address Line | 500 4TH ST NW STE 102
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-2104
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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 | PRINCIPLE
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Name | SAM DICKSTEIN
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Credential |
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Telephone | 980-360-1116
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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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