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NPI Code Detail

MEDICARE: FRAGILE X LIFE, ABA GROUP

MEDICARE: FRAGILE X LIFE, ABA GROUP
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1780249664
Entity Type Code : Organization
Provider Name (Legal Business Name) : FRAGILE X LIFE, ABA GROUP
Provider Business Mailing Address
First Line : 13010 MORRIS RD STE 600
Second Line :
City : ALPHARETTA
State : GA
Zip : 30004-5096
Country : US
Telephone Number : 770-300-7915
Fax Number : 470-826-4629
Provider Business Practice Location Address
First Line : 13010 MORRIS RD STE 600
Second Line :
City : ALPHARETTA
State : GA
Zip : 30004-5096
Country : US
Telephone Number : 770-300-7915
Fax Number : 470-826-4629
Authorized Official
Title or Position : BCBA
Name : TIMICA ROSSETTA RADDEN
Credential : BCBA
Telephone Number : 760-801-2015
Provider Enumeration Date : 05/06/2019
Last Update Date : 11/21/2025

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