Provider Demographics
NPI:1568096758
Name:ABOVE AND BEYOND ABA VA LLC
Entity Type:Organization
Organization Name:ABOVE AND BEYOND ABA VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MATT
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 1:212 2ND ST STE 202A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-3951
Mailing Address - Country:US
Mailing Address - Phone:732-806-0091
Mailing Address - Fax:732-813-8001
Practice Address - Street 1:4445 CORPORATION LN STE 264
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3262
Practice Address - Country:US
Practice Address - Phone:732-806-0091
Practice Address - Fax:732-813-8001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABOVE AND BEYOND CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty