Organization
HEARTLEAF ABA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY SEALS (NETWORK OPERATIONS DIRECTOR)
(207) 573-1000
Entity
Organization
Contact information
Practice address
396 GRIFFIN RD UNIT 106, BANGOR, ME 04401-3023
(207) 745-0750
Mailing address
396 GRIFFIN RD UNIT 106, BANGOR, ME 04401-3023
(207) 745-0750
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39604401
ADDRESS AND ZIP CODE
ME
Enumeration date
06/06/2022
Last updated
05/07/2024
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