MEDICARE: BEHAVIOR ANALYSIS SUPPORT 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	:	1649997420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIOR ANALYSIS SUPPORT SERVICES, INC

Provider Business Mailing Address
First Line	:	745 ORIENTA AVE STE 1011
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5675
Country	:	US
Telephone Number	:	877-823-4283
Fax Number	:	352-332-8589

Provider Business Practice Location Address
First Line	:	495 S NOVA RD STE 111
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8444
Country	:	US
Telephone Number	:	877-823-4283
Fax Number	:	352-332-8589

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOHN DENNIS ADELINIS
Credential	:
Telephone Number	:	877-823-4283

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	10/24/2022

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