Healthcare Provider Details

I. General information

NPI: 1295375681
Provider Name (Legal Business Name): RAINBOW ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4837 TELLSON PL
ORLANDO FL
32812-8673
US

IV. Provider business mailing address

4837 TELLSON PL
ORLANDO FL
32812-8673
US

V. Phone/Fax

Practice location:
  • Phone: 407-906-1477
  • Fax: 407-902-0187
Mailing address:
  • Phone: 407-906-1477
  • Fax: 407-902-0187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELIN IRENE CLARKE
Title or Position: CLINICAL DIRECTOR AND OWNER
Credential: BCBA
Phone: 407-906-1477