Provider Demographics
NPI:1235652587
Name:AQUATIC BEHAVIOR, LLC
Entity Type:Organization
Organization Name:AQUATIC BEHAVIOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANABRIA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:860-919-2209
Mailing Address - Street 1:4 KIMBALL CT APT 306
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6969
Mailing Address - Country:US
Mailing Address - Phone:860-919-2209
Mailing Address - Fax:617-401-8756
Practice Address - Street 1:4 KIMBALL CT APT 306
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6969
Practice Address - Country:US
Practice Address - Phone:860-919-2209
Practice Address - Fax:617-401-8756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty