MEDICARE: SUMMER ADAN

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	:	1477258424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER ADAN

Provider Business Mailing Address
First Line	:	786 MARLIN AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5423
Country	:	US
Telephone Number	:
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	:	718-222-5999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/31/2023

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Directions to “ SUMMER ADAN ” Practice Location

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