Provider Demographics
NPI:1154165371
Name:PIVOT ABA LLC
Entity type:Organization
Organization Name:PIVOT ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:608-436-9977
Mailing Address - Street 1:5012 GRANDE DR NW # NA
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-3306
Mailing Address - Country:US
Mailing Address - Phone:608-436-9977
Mailing Address - Fax:505-236-4831
Practice Address - Street 1:5012 GRANDE DR NW # NA
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3306
Practice Address - Country:US
Practice Address - Phone:608-436-9977
Practice Address - Fax:505-236-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty