Provider Demographics
NPI:1801405493
Name:ABA FOR ME LLC
Entity Type:Organization
Organization Name:ABA FOR ME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:PENMER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA COBA
Authorized Official - Phone:440-670-4611
Mailing Address - Street 1:291 BASSETT RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-1202
Mailing Address - Country:US
Mailing Address - Phone:440-670-4611
Mailing Address - Fax:
Practice Address - Street 1:291 BASSETT RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-1202
Practice Address - Country:US
Practice Address - Phone:440-670-4611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-13-13181OtherBOARD CERTIFIED BEHAVIOR ANALYST (BCBA)
OH354OtherCERTIFIED OHIO BEHAVIOR ANALYST