MEDICARE: CLOVER CARE 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	:	1770317075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOVER CARE ABA LLC

Provider Business Mailing Address
First Line	:	180 MILLER RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2332
Country	:	US
Telephone Number	:	848-240-2147
Fax Number	:	732-730-9661

Provider Business Practice Location Address
First Line	:	180 MILLER RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2332
Country	:	US
Telephone Number	:	848-240-2147
Fax Number	:	732-730-9661

Authorized Official
Title or Position	:	EMPLOYEE
Name	:	MR. SAM GOTTLIEB
Credential	:
Telephone Number	:	848-240-2147

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	08/28/2024

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Directions to “CLOVER CARE ABA LLC ” Practice Location

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