Healthcare Provider Details

I. General information

NPI: 1902711930
Provider Name (Legal Business Name): PREMIER ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 PARKER COMMONS BLVD # 106B
FORT MYERS FL
33912-1973
US

IV. Provider business mailing address

13420 PARKER COMMONS BLVD # 106B
FORT MYERS FL
33912-1973
US

V. Phone/Fax

Practice location:
  • Phone: 786-250-9798
  • Fax:
Mailing address:
  • Phone: 786-250-9798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL D URDANETA BOSCAN
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 786-250-9798