MEDICARE: EMANUEL ABA SERVICES 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356933709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMANUEL ABA SERVICES LLC

Provider Business Mailing Address
First Line	:	1326 N DIXIE HWY STE 1
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33460-1839
Country	:	US
Telephone Number	:	305-440-7162
Fax Number	:	561-431-5703

Provider Business Practice Location Address
First Line	:	1326 N DIXIE HWY STE 1
Second Line	:
City	:	LAKE WORTH BEACH
State	:	FL
Zip	:	33460-1839
Country	:	US
Telephone Number	:	305-440-7162
Fax Number	:	561-431-5703

Authorized Official
Title or Position	:	MANAGER
Name	:	EMMANUEL GOMEZ
Credential	:
Telephone Number	:	305-440-7162

Provider Enumeration Date	:	02/08/2021
Last Update Date	:	01/13/2026

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