Provider Demographics
NPI:1225674740
Name:PRIME ABA CONSULTANTS, LLC
Entity Type:Organization
Organization Name:PRIME ABA CONSULTANTS, LLC
Other - Org Name:PRIME ABA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LBS, BCBA, LBA
Authorized Official - Phone:570-871-4751
Mailing Address - Street 1:2000 ASH ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1546
Mailing Address - Country:US
Mailing Address - Phone:570-871-4751
Mailing Address - Fax:570-955-5323
Practice Address - Street 1:2000 ASH ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1546
Practice Address - Country:US
Practice Address - Phone:570-871-4751
Practice Address - Fax:570-955-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103589790Medicaid