Provider Demographics
NPI:1407625015
Name:CHRYSALIS ABA THERAPY CORP
Entity Type:Organization
Organization Name:CHRYSALIS ABA THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KOURACLES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, BCBA, LBA, IBA
Authorized Official - Phone:617-470-9827
Mailing Address - Street 1:6261 W ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5128
Mailing Address - Country:US
Mailing Address - Phone:561-359-3815
Mailing Address - Fax:561-816-4315
Practice Address - Street 1:6261 W ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5128
Practice Address - Country:US
Practice Address - Phone:617-470-9827
Practice Address - Fax:561-816-4315
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRYSALIS ABA THERAPY CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-22
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty