Healthcare Provider Details

I. General information

NPI: 1376353334
Provider Name (Legal Business Name): MITA ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 HARRISON ST STE 5A
HOLLYWOOD FL
33020-6839
US

IV. Provider business mailing address

3530 MYSTIC POINTE DR APT 608
AVENTURA FL
33180-4526
US

V. Phone/Fax

Practice location:
  • Phone: 786-540-0458
  • Fax: 754-551-2627
Mailing address:
  • Phone: 786-540-0458
  • Fax: 754-551-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TATIANA MIKHAYLOVA
Title or Position: BCBA
Credential: MS
Phone: 786-540-0458