Healthcare Provider Details

I. General information

NPI: 1164016168
Provider Name (Legal Business Name): IT TAKES A VILLAGE ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 SW SAVONA BLVD
PORT ST LUCIE FL
34953-2213
US

IV. Provider business mailing address

551 NW 82ND AVE APT 502
MIAMI FL
33126-3999
US

V. Phone/Fax

Practice location:
  • Phone: 786-522-2727
  • Fax: 850-795-4556
Mailing address:
  • Phone: 305-510-0185
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD A FREIRE
Title or Position: MEMBER
Credential:
Phone: 305-510-0185