Organization
BLUEBIRD ABA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN DEIKMAN MS, BCBA, LBS (MANAGING MEMBER)
(215) 586-1865
Entity
Organization
Contact information
Practice address
8222 WESTMINSTER RD, ELKINS PARK, PA 19027-1409
(215) 586-1865
Mailing address
8222 WESTMINSTER RD, ELKINS PARK, PA 19027-1409
(215) 586-1865
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
—
—
106S00000X
Behavior Technician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103615316-0001
—
PA
Enumeration date
09/23/2018
Last updated
01/06/2021
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