Healthcare Provider Details

I. General information

NPI: 1124554514
Provider Name (Legal Business Name): TEACHING WITH ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 EDGEWATER BND
PARKLAND FL
33076-4559
US

IV. Provider business mailing address

9131 EDGEWATER BND
PARKLAND FL
33076-4559
US

V. Phone/Fax

Practice location:
  • Phone: 954-495-6771
  • Fax:
Mailing address:
  • Phone: 954-495-6771
  • Fax:

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 StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: KIMBALLEE CHEUNG
Title or Position: BEHAVIOR ANALYST/ MANAGER
Credential:
Phone: 954-495-6771