Provider Demographics
NPI:1407459233
Name:PRESTIGE ABA THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:PRESTIGE ABA THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:401-678-0243
Mailing Address - Street 1:2461 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3221
Mailing Address - Country:US
Mailing Address - Phone:401-678-0243
Mailing Address - Fax:
Practice Address - Street 1:855 WATERMAN AVE STE D
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1700
Practice Address - Country:US
Practice Address - Phone:401-219-1351
Practice Address - Fax:401-210-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-16
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty