MEDICARE: ABA THERAPY SERVICES INC

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	:	1407514805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA THERAPY SERVICES INC

Provider Business Mailing Address
First Line	:	6801 LAKE WORTH RD STE 115
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-2965
Country	:	US
Telephone Number	:	561-283-7181
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 LAKE WORTH RD STE 115
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-2965
Country	:	US
Telephone Number	:	561-283-7181
Fax Number	:	561-909-0863

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HUMBERTO JESUS VALLADARES FRAGOSO
Credential	:
Telephone Number	:	305-301-6937

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	03/18/2026

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