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NPI Code Detail

MEDICARE: ATLANTIC ABA, LLC

MEDICARE: ATLANTIC ABA, 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
1103K00000XBehavior Analyst

Other Identifiers

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

General Provider Information

NPI Number : 1871170803
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATLANTIC ABA, LLC
Provider Business Mailing Address
First Line : 906 SEMINOLE DR
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-7648
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 906 SEMINOLE DR
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-7648
Country : US
Telephone Number : 772-216-2501
Fax Number :
Authorized Official
Title or Position : BCBA
Name : HOLLY BROLMANN
Credential :
Telephone Number : 772-216-2501
Provider Enumeration Date : 03/25/2021
Last Update Date : 03/27/2021

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Directions to “ATLANTIC ABA, LLC ” Practice Location

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