MEDICARE: STEADY STRIDES ABA TX PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1255004354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEADY STRIDES ABA TX PLLC

Provider Business Mailing Address
First Line	:	786 MARLIN AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5423
Country	:	US
Telephone Number	:	773-597-8799
Fax Number	:

Provider Business Practice Location Address
First Line	:	7723 MOONDANCE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2623
Country	:	US
Telephone Number	:	773-597-8799
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARAH BLUMENFELD
Credential	:
Telephone Number	:	773-597-8799

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	07/26/2021

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