Healthcare Provider Details

I. General information

NPI: 1922721950
Provider Name (Legal Business Name): BUBBLES ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 10/30/2022
Certification Date: 10/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BEACHSIDE DR
PONTE VEDRA BEACH FL
32082-4544
US

IV. Provider business mailing address

PO BOX 2231
PONTE VEDRA BEACH FL
32004-2231
US

V. Phone/Fax

Practice location:
  • Phone: 480-375-1122
  • Fax:
Mailing address:
  • Phone:
  • 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: MADISON PRZYDZIAL
Title or Position: BCBA, FOUNDER
Credential: MA,
Phone: 480-375-1122