Provider Demographics
NPI:1679061295
Name:PEDIATRIC ABA 2 INC
Entity Type:Organization
Organization Name:PEDIATRIC ABA 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:786-597-2047
Mailing Address - Street 1:3711 CORTEZ RD W STE 140
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3150
Mailing Address - Country:US
Mailing Address - Phone:786-597-2047
Mailing Address - Fax:
Practice Address - Street 1:3711 CORTEZ RD W STE 140
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3150
Practice Address - Country:US
Practice Address - Phone:786-597-2047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health