MEDICARE: APPLIED ABA THERAPY PA 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1285572594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLIED ABA THERAPY PA LLC

Provider Business Mailing Address
First Line	:	19 UNIVERSITY DR
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-9407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 UNIVERSITY DR
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-9407
Country	:	US
Telephone Number	:	860-460-7918
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	WENDY LAX
Credential	:
Telephone Number	:	860-460-7918

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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