Provider Demographics
NPI:1891950671
Name:BLUE PATH ABA
Entity Type:Organization
Organization Name:BLUE PATH ABA
Other - Org Name:APPLIED BEHAVIOR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HYNDI
Authorized Official - Middle Name:EDEN
Authorized Official - Last Name:KHOMUTETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:407-324-7772
Mailing Address - Street 1:1060 W SR 434 STE 108
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4953
Mailing Address - Country:US
Mailing Address - Phone:407-324-7772
Mailing Address - Fax:
Practice Address - Street 1:1060 W SR 434 STE 108
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4953
Practice Address - Country:US
Practice Address - Phone:407-324-7772
Practice Address - Fax:321-248-0717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 252Y00000X
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency