Provider Demographics
NPI:1578245551
Name:EVOLUTION ABA LLC
Entity type:Organization
Organization Name:EVOLUTION ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, LBS
Authorized Official - Phone:800-394-1106
Mailing Address - Street 1:2626 TRENTON AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-1814
Mailing Address - Country:US
Mailing Address - Phone:800-394-1106
Mailing Address - Fax:
Practice Address - Street 1:2626 TRENTON AVE APT 205
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-1814
Practice Address - Country:US
Practice Address - Phone:800-394-1106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0891886Medicaid