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General NPI Number Information
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NPI Number | 1679139919
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Entity Type | Organization
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Legal Business Name | ABA SQUAD INC
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 04/06/2023
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Provider Practice Location Address
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Address Line | 12747 OLIVE BLVD STE 300
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City | SAINT LOUIS
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State | MO
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Zip | 63141
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Country | US
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Telephone | 833-490-8535
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Fax | 786-800-5433
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Provider Business Mailing Address
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Address Line | PO BOX 347720
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City | CORAL GABLES
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State | FL
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Zip | 33234
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Country | US
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Telephone | 305-735-3878
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Fax | 786-800-5433
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Authorized Official
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Title or Position | CEO
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Name | MRS. JANET VASQUEZ
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Credential | BCBA, LBA
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Telephone | 305-290-2493
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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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Taxonomy #2
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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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