Healthcare Provider Details

I. General information

NPI: 1760838015
Provider Name (Legal Business Name): CHRYSALIS ABA THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 W ATLANTIC AVE SUITE 114
DELRAY BEACH FL
33484-8103
US

IV. Provider business mailing address

5180 W ATLANTIC AVE STE 112
DELRAY BEACH FL
33484-8103
US

V. Phone/Fax

Practice location:
  • Phone: 561-674-9996
  • Fax:
Mailing address:
  • Phone: 561-359-3815
  • Fax: 561-816-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: BEATRIZ E KOURACLES
Title or Position: MANAGER
Credential: MBA, BCBA, LBA, IBA
Phone: 617-470-9827