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General NPI Number Information
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NPI Number | 1922958180
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Entity Type | Organization
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Legal Business Name | RADICAL ABA, LLC
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Dates
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Enumeration Date | 01/29/2026
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 2459 MAVERICK WAY
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City | THE VILLAGES
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State | FL
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Zip | 32162-5101
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Country | US
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Telephone | 815-262-8466
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Fax |
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Provider Business Mailing Address
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Address Line | 2459 MAVERICK WAY
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City | THE VILLAGES
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State | FL
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Zip | 32162-5101
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Country | US
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Telephone | 815-262-8466
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KATHERINE LYNN PETRUSA
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Credential | BCBA
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Telephone | 815-262-8466
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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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