Provider Demographics
NPI:1326817701
Name:ABA AUTISM THERAPY OF FLORIDA LLC
Entity Type:Organization
Organization Name:ABA AUTISM THERAPY OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GWILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:305-300-9796
Mailing Address - Street 1:2598 E SUNRISE BLVD STE 2104
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3230
Mailing Address - Country:US
Mailing Address - Phone:954-235-1530
Mailing Address - Fax:
Practice Address - Street 1:2598 E SUNRISE BLVD STE 2104
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3230
Practice Address - Country:US
Practice Address - Phone:954-235-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health