MEDICARE: CROWN ABA VA 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	:	1750240925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN ABA VA LLC

Provider Business Mailing Address
First Line	:	23 BERNARD ST
Second Line	:
City	:	LAWRENCE
State	:	NY
Zip	:	11559-1236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21000 SOUTHBANK ST STE 106
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20165-7242
Country	:	US
Telephone Number	:	410-995-8388
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ARI LEVINE
Credential	:
Telephone Number	:	410-995-8388

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “CROWN ABA VA LLC ” Practice Location

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