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General NPI Number Information
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NPI Number | 1548864556
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Entity Type | Organization
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Legal Business Name | ALL FLORIDA ABA CORP
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Dates
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Enumeration Date | 11/30/2020
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 5240 BANK ST STE 14
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City | FORT MYERS
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State | FL
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Zip | 33907-2110
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Country | US
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Telephone | 786-269-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 5540 BANK ST SUIT 14
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City | FORT MYERS
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State | FL
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Zip | 33907
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Country | US
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Telephone | 786-269-8757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | REYDEL LOPEZ MENDEZ
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Credential |
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Telephone | 786-269-8757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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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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