Provider Demographics
NPI:1265059646
Name:XYZABA LLC
Entity type:Organization
Organization Name:XYZABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUEK
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:631-375-3190
Mailing Address - Street 1:766 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2330
Mailing Address - Country:US
Mailing Address - Phone:631-375-3190
Mailing Address - Fax:
Practice Address - Street 1:766 OAK AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2330
Practice Address - Country:US
Practice Address - Phone:631-375-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty