Provider Demographics
NPI:1447000880
Name:DISCOVERY ABA ME LLC
Entity type:Organization
Organization Name:DISCOVERY ABA ME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-736-5689
Mailing Address - Street 1:600 BAYVIEW AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11096-1606
Mailing Address - Country:US
Mailing Address - Phone:718-675-6957
Mailing Address - Fax:
Practice Address - Street 1:443 WESTERN AVE STE 1049
Practice Address - Street 2:
Practice Address - City:S PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1726
Practice Address - Country:US
Practice Address - Phone:718-736-5689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health