Provider Demographics
NPI:1134635907
Name:NORTHEAST ABA SERVICES, LLC
Entity Type:Organization
Organization Name:NORTHEAST ABA SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JUZBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-244-1732
Mailing Address - Street 1:145 FEEDING HILLS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9588
Mailing Address - Country:US
Mailing Address - Phone:413-244-1732
Mailing Address - Fax:
Practice Address - Street 1:145 FEEDING HILLS RD
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9588
Practice Address - Country:US
Practice Address - Phone:413-244-1732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1691103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty