=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720877558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPPORTIVE STEPS ABA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2025
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 534 HARVARD PL
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-4964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-373-3417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 534 HARVARD PL
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-4964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-373-3417
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MR. EDWIN ANTHONY RICHARDSON JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-373-3417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------