Provider Demographics
NPI:1053629824
Name:ABA OUTREACH SERVICES
Entity Type:Organization
Organization Name:ABA OUTREACH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE NAMETH
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:216-272-3963
Mailing Address - Street 1:5199 LYND AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1028
Mailing Address - Country:US
Mailing Address - Phone:216-272-3963
Mailing Address - Fax:216-674-2304
Practice Address - Street 1:199 S CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8830
Practice Address - Country:US
Practice Address - Phone:216-272-3963
Practice Address - Fax:216-674-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1096020103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty