Healthcare Provider Details

I. General information

NPI: 1912818113
Provider Name (Legal Business Name): ABAK BEHAVIOR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 79TH AVE STE 222
DORAL FL
33122-1085
US

IV. Provider business mailing address

2500 NW 79TH AVE STE 222
DORAL FL
33122-1085
US

V. Phone/Fax

Practice location:
  • Phone: 786-408-0238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KEILYN C MARTINEZ
Title or Position: CEO
Credential: BCBA
Phone: 786-408-0238