Provider Demographics
NPI:1063141174
Name:HEARTLEAF ABA LLC
Entity type:Organization
Organization Name:HEARTLEAF ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEALS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-573-1000
Mailing Address - Street 1:396 GRIFFIN RD UNIT 106
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3023
Mailing Address - Country:US
Mailing Address - Phone:207-745-0750
Mailing Address - Fax:
Practice Address - Street 1:396 GRIFFIN RD UNIT 106
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3023
Practice Address - Country:US
Practice Address - Phone:207-745-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental HealthGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME39604401OtherADDRESS AND ZIP CODE