Healthcare Provider Details

I. General information

NPI: 1336912427
Provider Name (Legal Business Name): ABASI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 MILL CREEK DR
YOUNGSTOWN OH
44512-1549
US

IV. Provider business mailing address

66 MILL CREEK DR
YOUNGSTOWN OH
44512-1549
US

V. Phone/Fax

Practice location:
  • Phone: 561-279-3852
  • Fax: 561-437-8116
Mailing address:
  • Phone: 561-279-3852
  • Fax: 561-437-8116

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 State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JUSTYN HARVEY
Title or Position: FOUNDER/OWNER
Credential: BCBA
Phone: 904-415-4661