Provider Demographics
NPI:1689381089
Name:BEHAVIOR ANALYSIS SUPPORT SERVICES
Entity Type:Organization
Organization Name:BEHAVIOR ANALYSIS SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:ADELINIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-332-8588
Mailing Address - Street 1:745 ORIENTA AVE STE 1011
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5675
Mailing Address - Country:US
Mailing Address - Phone:877-823-4283
Mailing Address - Fax:352-332-8589
Practice Address - Street 1:550 WELLS RD STE 3
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2950
Practice Address - Country:US
Practice Address - Phone:877-823-4283
Practice Address - Fax:352-332-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty