Provider Demographics
NPI:1083500490
Name:GOLD HEART ABA MD LLC
Entity type:Organization
Organization Name:GOLD HEART ABA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YEHOUSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-813-5603
Mailing Address - Street 1:5700 SMITH AVE UNIT 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3610
Mailing Address - Country:US
Mailing Address - Phone:732-637-9359
Mailing Address - Fax:732-719-5787
Practice Address - Street 1:5700 SMITH AVE UNIT 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3610
Practice Address - Country:US
Practice Address - Phone:732-637-9359
Practice Address - Fax:732-719-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health