Provider Demographics
NPI:1295622850
Name:PROUD ABA LLC
Entity type:Organization
Organization Name:PROUD ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-859-5431
Mailing Address - Street 1:57 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4127
Mailing Address - Country:US
Mailing Address - Phone:315-859-5431
Mailing Address - Fax:
Practice Address - Street 1:57 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-4127
Practice Address - Country:US
Practice Address - Phone:201-449-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health