Provider Demographics
NPI:1669199436
Name:YOUR LIFE ABA PA, LLC
Entity type:Organization
Organization Name:YOUR LIFE ABA PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING & INSURANCE CONTRACTI
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:STEIN
Authorized Official - Last Name:GREENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-525-4271
Mailing Address - Street 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:609-525-4271
Mailing Address - Fax:443-743-3863
Practice Address - Street 1:1196 E WASHINGTON LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-1044
Practice Address - Country:US
Practice Address - Phone:215-866-0200
Practice Address - Fax:215-866-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty