=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558079145
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABA THERAPY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2022
-----------------------------------------------------
Last Update Date | 03/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1740 SW 149TH PASS
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33185-5783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-815-0931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1740 SW 149TH PASS
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33185-5783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-815-0931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BCBA
-----------------------------------------------------
Name | YANELA ESTHER ARTEAGA SIMON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-815-0931
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------