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General NPI Number Information
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NPI Number | 1942016464
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Entity Type | Organization
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Legal Business Name | SHINING HEARTS ABA
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 2425 WALL ST SE
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City | CONYERS
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State | GA
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Zip | 30013-6342
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Country | US
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Telephone | 845-376-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 36 AIRPORT RD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-7034
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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 | CEO
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Name | MRS. MIRIAM MERMELSTEIN
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Credential |
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Telephone | 845-376-2226
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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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