Healthcare Provider Details

I. General information

NPI: 1528501640
Provider Name (Legal Business Name): AUTISM INTERACTS ABA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12356 MOSS LAKE LOOP
TRINITY FL
34655
US

IV. Provider business mailing address

12356 MOSS LAKE LOOP
TRINITY FL
34655
US

V. Phone/Fax

Practice location:
  • Phone: 727-597-2280
  • Fax:
Mailing address:
  • Phone: 727-597-2280
  • 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: SANDRA TRIGLIA
Title or Position: OWNER/PRESIDENT
Credential: BCBA
Phone: 727-597-2280