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General NPI Number Information
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NPI Number | 1922824770
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Entity Type | Organization
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Legal Business Name | ACTIFY ABA THERAPY MD, LLC
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 6340 SECURITY BLVD STE 100-1227
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City | BALTIMORE
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State | MD
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Zip | 21207-5173
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Country | US
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Telephone | 410-929-0988
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Fax | 410-204-1915
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Provider Business Mailing Address
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Address Line | 6340 SECURITY BLVD STE 100-1227
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City | BALTIMORE
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State | MD
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Zip | 21207-5173
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Country | US
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Telephone | 410-929-0988
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Fax | 410-204-1915
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Authorized Official
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Title or Position | DIRECTOR
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Name | YISROEL GOLDBERG
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Credential |
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Telephone | 410-929-0988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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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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