Provider Demographics
NPI:1104791276
Name:EVOLVIA ABA SERVICES CORP
Entity type:Organization
Organization Name:EVOLVIA ABA SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMEIRYS
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCOURT VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-399-4789
Mailing Address - Street 1:311 NE 19TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-5253
Mailing Address - Country:US
Mailing Address - Phone:305-206-9200
Mailing Address - Fax:
Practice Address - Street 1:3979 NORTHSIDE CIRCLE UNIT 2
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3650
Practice Address - Country:US
Practice Address - Phone:305-206-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty