=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346950136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABA THERAPY AND EDUCATION, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2022
-----------------------------------------------------
Last Update Date | 02/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24338 SW 108TH AVE
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-5159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-898-9050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24338 SW 108TH AVE
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-5159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-898-9050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CARLOS LOPEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-898-9050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------