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General NPI Number Information
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NPI Number | 1235045857
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Entity Type | Organization
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Legal Business Name | MITA ABA LLC
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Dates
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Enumeration Date | 08/22/2026
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Last Update Date | 08/22/2026
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Provider Practice Location Address
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Address Line | 1720 HARRISON ST STE 5A
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City | HOLLYWOOD
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State | FL
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Zip | 33020-6839
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Country | US
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Telephone | 786-540-0458
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Fax | 754-551-2627
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Provider Business Mailing Address
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Address Line | 3530 MYSTIC POINTE DR APT 608
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City | AVENTURA
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State | FL
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Zip | 33180-4526
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Country | US
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Telephone | 786-540-0458
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Fax | 754-551-2627
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | TATIANA MIKHAYLOVA
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Credential | MS
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Telephone | 786-540-0458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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