MEDICARE: IT TAKES A VILLAGE ABA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1164016168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IT TAKES A VILLAGE ABA, LLC

Provider Business Mailing Address
First Line	:	551 NW 82ND AVE APT 502
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3999
Country	:	US
Telephone Number	:	305-510-0185
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 SW SAVONA BLVD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-2213
Country	:	US
Telephone Number	:	786-522-2727
Fax Number	:	850-795-4556

Authorized Official
Title or Position	:	MEMBER
Name	:	RICHARD A FREIRE
Credential	:
Telephone Number	:	305-510-0185

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	07/21/2025

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