Healthcare Provider Details

I. General information

NPI: 1982361085
Provider Name (Legal Business Name): ABA CLINICAL SUPPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 02/18/2023
Certification Date: 02/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20541 SW 79TH CT
CUTLER BAY FL
33189-2184
US

IV. Provider business mailing address

20541 SW 79TH CT
CUTLER BAY FL
33189-2184
US

V. Phone/Fax

Practice location:
  • Phone: 561-305-1422
  • Fax: 561-516-6538
Mailing address:
  • Phone: 561-305-1422
  • Fax: 561-516-6538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANIEL DIAZ PANDO
Title or Position: OWNER/OFFICE MANAGER
Credential:
Phone: 786-991-3706