Provider Demographics
NPI:1508579335
Name:ABA FAMILY SUPPORT INC
Entity Type:Organization
Organization Name:ABA FAMILY SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISKAY
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:SANTANA DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-610-9593
Mailing Address - Street 1:1400 SW 131ST WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2453
Mailing Address - Country:US
Mailing Address - Phone:754-610-9593
Mailing Address - Fax:
Practice Address - Street 1:1400 SW 131ST WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-2453
Practice Address - Country:US
Practice Address - Phone:754-610-9593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty