Healthcare Provider Details

I. General information

NPI: 1942113469
Provider Name (Legal Business Name): ABA THERAPY TITAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CROSSING BLVD FL 1
ORANGE PARK FL
32073-6204
US

IV. Provider business mailing address

330 CROSSING BLVD FL 1
ORANGE PARK FL
32073-6204
US

V. Phone/Fax

Practice location:
  • Phone: 904-901-0004
  • Fax: 904-901-0004
Mailing address:
  • Phone: 904-901-0004
  • Fax: 904-901-0004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GEOVANNI ROMERO
Title or Position: AUTHORIZED MEMBER / PRESIDENT
Credential:
Phone: 904-901-0004