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NPI Code Detail

MEDICARE: BOLD STEPS ABA OF IN LLC

MEDICARE: BOLD STEPS ABA OF IN 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1750014569
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOLD STEPS ABA OF IN LLC
Provider Business Mailing Address
First Line : 334 N SENATE AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46204-1708
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 334 N SENATE AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46204-1708
Country : US
Telephone Number : 718-686-8292
Fax Number :
Authorized Official
Title or Position : CEO
Name : CHAIM BERGER
Credential :
Telephone Number : 718-686-8292
Provider Enumeration Date : 07/08/2022
Last Update Date : 07/08/2022

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Directions to “BOLD STEPS ABA OF IN LLC ” Practice Location

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