Provider Demographics
NPI:1073135414
Name:SOCIALLY SIGNIFICANT APPLIED BEHAVIOR ANALYSIS
Entity Type:Organization
Organization Name:SOCIALLY SIGNIFICANT APPLIED BEHAVIOR ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTEN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:321-750-9803
Mailing Address - Street 1:148 FELDMAN ST SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-8968
Mailing Address - Country:US
Mailing Address - Phone:321-750-9803
Mailing Address - Fax:
Practice Address - Street 1:148 FELDMAN ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-8968
Practice Address - Country:US
Practice Address - Phone:321-750-9803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty