MEDICARE: NEUROSPROUT ABA MD 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1659164358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROSPROUT ABA MD LLC

Provider Business Mailing Address
First Line	:	8 KIELT WAY BSMT
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5097
Country	:	US
Telephone Number	:	410-357-1180
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 YORK RD STE 800-1030
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6035
Country	:	US
Telephone Number	:	213-332-8893
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	YITZCHAK SELEH
Credential	:
Telephone Number	:	213-333-4433

Provider Enumeration Date	:	05/26/2025
Last Update Date	:	09/09/2025

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