Healthcare Provider Details

I. General information

NPI: 1215673959
Provider Name (Legal Business Name): BEHAVIOR ANALYSIS SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 US HIGHWAY 1 S STE 202
ST AUGUSTINE FL
32086-6363
US

IV. Provider business mailing address

2035 SW 75TH ST STE B
GAINESVILLE FL
32607-3425
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-4283
  • Fax: 352-332-8589
Mailing address:
  • Phone: 877-823-4283
  • Fax: 352-332-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN DENNIS ADELINIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 352-332-8588