Provider Demographics
NPI:1295372142
Name:MOMENTUM APPLIED BEHAVIORAL ANALYSIS
Entity Type:Organization
Organization Name:MOMENTUM APPLIED BEHAVIORAL ANALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIOR ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ARON
Authorized Official - Last Name:YASOVA-ZAFFOS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:727-666-1963
Mailing Address - Street 1:5018 CAMBERLEY LN
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-5113
Mailing Address - Country:US
Mailing Address - Phone:727-666-1963
Mailing Address - Fax:
Practice Address - Street 1:5018 CAMBERLEY LN
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-5113
Practice Address - Country:US
Practice Address - Phone:727-666-1963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty