Provider Demographics
NPI:1568014447
Name:ABASS, IMOLEAYO O (BCBA)
Entity Type:Individual
Prefix:MR
First Name:IMOLEAYO
Middle Name:O
Last Name:ABASS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 E NEWTOWN PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2974
Mailing Address - Country:US
Mailing Address - Phone:929-364-3656
Mailing Address - Fax:
Practice Address - Street 1:67 E NEWTOWN PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-2974
Practice Address - Country:US
Practice Address - Phone:929-364-3656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1-20-45959103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst