Provider Demographics
NPI:1811601982
Name:MAXIMIZING INTENTIONAL ABA
Entity type:Organization
Organization Name:MAXIMIZING INTENTIONAL ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LBS
Authorized Official - Phone:610-574-3926
Mailing Address - Street 1:6127 LENSEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-1020
Mailing Address - Country:US
Mailing Address - Phone:610-574-3926
Mailing Address - Fax:
Practice Address - Street 1:6127 LENSEN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1020
Practice Address - Country:US
Practice Address - Phone:610-574-3926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAXIMIZING INTENTIONAL ABA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health