MEDICARE: SPRING FORWARD ABA LLC

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	:	1518701655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING FORWARD ABA LLC

Provider Business Mailing Address
First Line	:	12 BARNEGAT LN
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-3229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 WESTSIDE BLVD NW # 1
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24017-6784
Country	:	US
Telephone Number	:	540-598-7260
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MEIR WISE
Credential	:
Telephone Number	:	540-598-7260

Provider Enumeration Date	:	06/24/2024
Last Update Date	:	12/18/2025

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Directions to “SPRING FORWARD ABA LLC ” Practice Location

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