Healthcare Provider Details

I. General information

NPI: 1124957733
Provider Name (Legal Business Name): PALM BEACH ABA THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SKY PINE WAY APT H2
GREENACRES FL
33415-9036
US

IV. Provider business mailing address

820 SKY PINE WAY APT H2
GREENACRES FL
33415-9036
US

V. Phone/Fax

Practice location:
  • Phone: 561-420-3902
  • Fax:
Mailing address:
  • Phone: 561-420-3902
  • 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: VICTOR OMAR PENA
Title or Position: OWNWER/CEO
Credential:
Phone: 561-420-3902