Provider Demographics
NPI:1093203614
Name:PEDIATRIC ABA 4 INC
Entity Type:Organization
Organization Name:PEDIATRIC ABA 4 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:ABABA
Authorized Official - Phone:786-597-2047
Mailing Address - Street 1:123 NW 13TH ST STE 30410
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1645
Mailing Address - Country:US
Mailing Address - Phone:786-597-2047
Mailing Address - Fax:
Practice Address - Street 1:123 NW 13TH ST STE 30410
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1645
Practice Address - Country:US
Practice Address - Phone:786-597-2047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health