Provider Demographics
NPI:1760677017
Name:BEHAVIOR ANALYSIS SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:BEHAVIOR ANALYSIS SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:ADELINIS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA, MA
Authorized Official - Phone:352-332-8588
Mailing Address - Street 1:PO BOX 357370
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7370
Mailing Address - Country:US
Mailing Address - Phone:352-332-8588
Mailing Address - Fax:352-332-8589
Practice Address - Street 1:1000 NE 16TH AVE BLDG D
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4541
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:2007-09-10
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686363996Medicaid