Provider Demographics
NPI:1598571317
Name:BLUE MOUNTAIN ABA LLC
Entity type:Organization
Organization Name:BLUE MOUNTAIN ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MALKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-275-9654
Mailing Address - Street 1:1308 DINSMORE AVE
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3410 N HIGH SCHOOL RD STE G
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-1100
Practice Address - Country:US
Practice Address - Phone:516-427-9582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty