| Proud Moments Aba Of Georgia Llc | |
|
350 5th Ave Ste 6115 New York NY 10118-6002 | |
| (718) 215-5311 | |
| Not Available |
| Full Name | Proud Moments Aba Of Georgia Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 350 5th Ave Ste 6115, New York, New York |
| Authorized Official Name and Position | Mark Yost (GENERAL COUNSEL) |
| Authorized Official Contact | 7182155311 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Proud Moments Aba Of Georgia Llc 350 5th Ave Ste 6115 New York NY 10118-6002 Ph: (718) 215-5311 | Proud Moments Aba Of Georgia Llc 350 5th Ave Ste 6115 New York NY 10118-6002 Ph: (718) 215-5311 |
| NPI Number | 1255085551 |
|---|---|
| Provider Enumeration Date | 02/07/2022 |
| Last Update Date | 02/13/2025 |
| Certification Date | 02/13/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255085551 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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