MEDICARE: SPRINGBOARD 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	:	1609696111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGBOARD ABA LLC

Provider Business Mailing Address
First Line	:	300 N MAIN ST STE 303
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-3774
Country	:	US
Telephone Number	:	845-633-4539
Fax Number	:

Provider Business Practice Location Address
First Line	:	10801 PAUL EELLS DR
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-7608
Country	:	US
Telephone Number	:	845-633-4539
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. MARK FEUER
Credential	:
Telephone Number	:	845-633-4539

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	10/10/2024

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Directions to “SPRINGBOARD ABA LLC ” Practice Location

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