Provider Demographics
NPI:1962149260
Name:PROUD MOMENTS ABA SERVICES LLC
Entity type:Organization
Organization Name:PROUD MOMENTS ABA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:YOST
Authorized Official - Suffix:JR
Authorized Official - Credentials:ESQ
Authorized Official - Phone:718-215-5311
Mailing Address - Street 1:350 5TH AVE STE 6115
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10118-6002
Mailing Address - Country:US
Mailing Address - Phone:718-215-5311
Mailing Address - Fax:
Practice Address - Street 1:350 5TH AVE STE 6115
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10118-6002
Practice Address - Country:US
Practice Address - Phone:718-215-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty