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General NPI Number Information
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NPI Number | 1639769276
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Entity Type | Organization
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Legal Business Name | MY ABA FAMILY LLC
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 238 WILSHIRE BLVD STE 155
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City | CASSELBERRY
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State | FL
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Zip | 32707-5362
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Country | US
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Telephone | 203-510-9325
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Fax | 407-704-2556
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Provider Business Mailing Address
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Address Line | 10308 BROWNWOOD AVE
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City | ORLANDO
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State | FL
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Zip | 32825-6628
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Country | US
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Telephone | 203-228-7577
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | MR. YANKO BERMUDEZ VILLA
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Credential |
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Telephone | 203-510-9325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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