Provider Demographics
NPI:1134654130
Name:CMM ABA, LLC
Entity Type:Organization
Organization Name:CMM ABA, LLC
Other - Org Name:PIECE OF THE PUZZLE BEHAVIOR ANALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, MS
Authorized Official - Phone:305-393-0179
Mailing Address - Street 1:706 TURTLE COVE LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 27TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4011
Practice Address - Country:US
Practice Address - Phone:305-393-0179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019806100Medicaid