Healthcare Provider Details

I. General information

NPI: 1295372142
Provider Name (Legal Business Name): MOMENTUM APPLIED BEHAVIORAL ANALYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5018 CAMBERLEY LN
OLDSMAR FL
34677-5113
US

IV. Provider business mailing address

5018 CAMBERLEY LN
OLDSMAR FL
34677-5113
US

V. Phone/Fax

Practice location:
  • Phone: 727-666-1963
  • Fax:
Mailing address:
  • Phone: 727-666-1963
  • 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: MR. MATTHEW ARON YASOVA-ZAFFOS
Title or Position: BOARD CERTIFIED BEHAVIOR ANALYST
Credential: BCBA
Phone: 727-666-1963