Provider Demographics
NPI:1871993113
Name:LOOMIS, ABIGAIL TRAJTENBERG (BCBA)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:TRAJTENBERG
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:TRAJTENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:583 SHOEMAKER RD STE 230
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4238
Mailing Address - Country:US
Mailing Address - Phone:484-681-2170
Mailing Address - Fax:425-658-3017
Practice Address - Street 1:583 SHOEMAKER RD STE 230
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4238
Practice Address - Country:US
Practice Address - Phone:484-681-2170
Practice Address - Fax:425-658-3017
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-17-26487103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst