Provider Demographics
NPI:1407523160
Name:ABOVE AND BEYOND ABA NC LLC
Entity Type:Organization
Organization Name:ABOVE AND BEYOND ABA NC LLC
Other - Org Name:ABOVE AND BEYOND ABA CORPORATE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MATTISYAHU
Authorized Official - Middle Name:
Authorized Official - Last Name:ROKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:732-806-0091
Mailing Address - Street 1:311 BOULEVARD OF THE AMERICAS
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701
Mailing Address - Country:US
Mailing Address - Phone:732-806-0091
Mailing Address - Fax:
Practice Address - Street 1:101 N TRYON ST STE 112
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28246-0104
Practice Address - Country:US
Practice Address - Phone:732-806-0091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABOVE AND BEYOND ABA CORPORATE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-30
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty