MEDICARE: ELIZABETH ALEXANDRA VIDAS BCABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst
3	106S00000X	Behavior Technician

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	:	1952984122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ALEXANDRA VIDAS BCABA

Provider Business Mailing Address
First Line	:	PO BOX 6553
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33807-6553
Country	:	US
Telephone Number	:	863-602-0698
Fax Number	:	813-354-2715

Provider Business Practice Location Address
First Line	:	10150 HIGHLANDS MANOR DRIVE
Second Line	:	SUITE 200
City	:	TAMPA
State	:	FL
Zip	:	33610
Country	:	US
Telephone Number	:	863-602-0698
Fax Number	:	813-354-2715

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	01/07/2026

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