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General NPI Number Information
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NPI Number | 1669948741
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE ABA THERAPY GROUP, LLC
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Dates
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Enumeration Date | 10/16/2018
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Last Update Date | 10/16/2018
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Provider Practice Location Address
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Address Line | 1036 OLD FURNACE RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44511-1338
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Country | US
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Telephone | 330-518-2109
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Fax |
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Provider Business Mailing Address
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Address Line | 1036 OLD FURNACE RD
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City | YOUNGSTOWN
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State | OH
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Zip | 44511-1338
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Country | US
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Telephone | 330-518-2109
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | DR. STEPHEN RAY FLORA
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Credential | PHD
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Telephone | 330-518-2109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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