MEDICARE: ABA SHAPING SERVICE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QP1100X	Podiatric Clinic/Center
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1356023410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA SHAPING SERVICE LLC

Provider Business Mailing Address
First Line	:	9918 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5041
Country	:	US
Telephone Number	:	929-551-8799
Fax Number	:

Provider Business Practice Location Address
First Line	:	9918 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5041
Country	:	US
Telephone Number	:	929-551-8799
Fax Number	:

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	MS. MARSHA D MCKENZIE
Credential	:	BCBA/LBA
Telephone Number	:	929-551-8799

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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