Provider Demographics
NPI:1497445332
Name:PATRICK'S ABA LLC
Entity Type:Organization
Organization Name:PATRICK'S ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED BEHAVIORAL TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MAHOTIERE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:786-339-3396
Mailing Address - Street 1:224 NE 23RD TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6220
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:224 NE 23RD TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6220
Practice Address - Country:US
Practice Address - Phone:786-339-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health