Provider Demographics
NPI:1871253138
Name:ABA APPLIED BEHAVIOR SOLUTIONS LLC
Entity Type:Organization
Organization Name:ABA APPLIED BEHAVIOR SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESTELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:RODRIGUEZ CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-420-8999
Mailing Address - Street 1:1500 COLONIAL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1025
Mailing Address - Country:US
Mailing Address - Phone:786-420-8999
Mailing Address - Fax:239-294-0903
Practice Address - Street 1:1500 COLONIAL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1025
Practice Address - Country:US
Practice Address - Phone:786-420-8999
Practice Address - Fax:239-294-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112928200Medicaid