Provider Demographics
NPI:1841160777
Name:INTELLISTARS ABA MD
Entity type:Organization
Organization Name:INTELLISTARS ABA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:470-704-5219
Mailing Address - Street 1:1980 SWARTHMORE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4765
Mailing Address - Country:US
Mailing Address - Phone:470-704-5219
Mailing Address - Fax:
Practice Address - Street 1:16701 MELFORD BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4411
Practice Address - Country:US
Practice Address - Phone:470-704-5219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty