=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629787429
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAISE ABA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2022
-----------------------------------------------------
Last Update Date | 02/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11205 S DIXIE HWY STE 201
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-4447
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-799-4542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1030 NE 30TH AVE
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33033-7608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-799-4542
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | VIOLET DEL ROSARIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-799-4542
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------