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NPI Code Detail

MEDICARE: PROUD MOMENTS ABA

MEDICARE: PROUD MOMENTS ABA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1558294728
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROUD MOMENTS ABA
Provider Business Mailing Address
First Line : 7724 MAPLE AVE APT 14
Second Line :
City : TAKOMA PARK
State : MD
Zip : 20912-5652
Country : US
Telephone Number : 240-956-9658
Fax Number :
Provider Business Practice Location Address
First Line : 4961 TESLA DR STE A-C
Second Line :
City : BOWIE
State : MD
Zip : 20715-4405
Country : US
Telephone Number : 301-329-8155
Fax Number :
Authorized Official
Title or Position : BEHAVIORAL TECH
Name : MARIELA R SAMUEL
Credential :
Telephone Number : 240-956-9658
Provider Enumeration Date : 06/05/2026
Last Update Date : 06/05/2026

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Directions to “PROUD MOMENTS ABA ” Practice Location

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