Provider Demographics
NPI:1598491953
Name:STILL WATER ABA, LLC
Entity Type:Organization
Organization Name:STILL WATER ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER BCBA
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SCOLARICI
Authorized Official - Suffix:III
Authorized Official - Credentials:BCBA
Authorized Official - Phone:618-975-6737
Mailing Address - Street 1:9701 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-4203
Mailing Address - Country:US
Mailing Address - Phone:618-975-6737
Mailing Address - Fax:
Practice Address - Street 1:9701 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-4203
Practice Address - Country:US
Practice Address - Phone:618-975-6737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty