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NPI Code Detail

MEDICARE: BLUE PATH ABA

MEDICARE: BLUE PATH ABA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1891950671
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE PATH ABA
Provider Business Mailing Address
First Line : 1060 W SR 434 STE 108
Second Line :
City : LONGWOOD
State : FL
Zip : 32750-4953
Country : US
Telephone Number : 407-324-7772
Fax Number :
Provider Business Practice Location Address
First Line : 1060 W SR 434 STE 108
Second Line :
City : LONGWOOD
State : FL
Zip : 32750-4953
Country : US
Telephone Number : 407-324-7772
Fax Number : 321-248-0717
Authorized Official
Title or Position : OWNER
Name : MRS. HYNDI EDEN KHOMUTETSKY
Credential : MS, BCBA
Telephone Number : 407-324-7772
Provider Enumeration Date : 07/22/2008
Last Update Date : 08/29/2023

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Directions to “BLUE PATH ABA ” Practice Location

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