Provider Demographics
NPI:1629836440
Name:KIWI ABA
Entity Type:Organization
Organization Name:KIWI ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MORDECHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:CUKIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-846-6193
Mailing Address - Street 1:2320 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4541
Mailing Address - Country:US
Mailing Address - Phone:917-846-6193
Mailing Address - Fax:
Practice Address - Street 1:6312 S FIDDLERS GREEN CIR STE 300E
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4831
Practice Address - Country:US
Practice Address - Phone:917-846-6193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty