Provider Demographics
NPI:1659164358
Name:NEUROSPROUT ABA MD LLC
Entity type:Organization
Organization Name:NEUROSPROUT ABA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SELEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-333-4433
Mailing Address - Street 1:8 KIELT WAY BSMT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5097
Mailing Address - Country:US
Mailing Address - Phone:410-357-1180
Mailing Address - Fax:
Practice Address - Street 1:1301 YORK RD STE 800-1030
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6035
Practice Address - Country:US
Practice Address - Phone:213-332-8893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-26
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty