MEDICARE: ABA BEHAVIOR INTERVENTION 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

General Provider Information

NPI Number	:	1912602806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA BEHAVIOR INTERVENTION LLC

Provider Business Mailing Address
First Line	:	261 W ADELAIDE DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-6929
Country	:	US
Telephone Number	:	954-931-1803
Fax Number	:	888-353-5181

Provider Business Practice Location Address
First Line	:	261 W ADELAIDE DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-6929
Country	:	US
Telephone Number	:	954-931-1803
Fax Number	:	888-353-5181

Authorized Official
Title or Position	:	OWNER
Name	:	JUAN ANTONIO RODRIGUEZ
Credential	:
Telephone Number	:	305-956-8107

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	01/29/2025

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