Provider Demographics
NPI:1639769276
Name:MY ABA FAMILY LLC
Entity Type:Organization
Organization Name:MY ABA FAMILY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:MR
Authorized Official - First Name:JANEISY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ DEL SOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-228-7757
Mailing Address - Street 1:10308 BROWNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-6628
Mailing Address - Country:US
Mailing Address - Phone:203-228-7577
Mailing Address - Fax:
Practice Address - Street 1:10308 BROWNWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-6628
Practice Address - Country:US
Practice Address - Phone:203-228-7577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health