Provider Demographics
NPI:1154137586
Name:BENNETT ABA THERAPY LLC
Entity type:Organization
Organization Name:BENNETT ABA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BEG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-516-9685
Mailing Address - Street 1:430 SW 182ND WAY
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-4317
Mailing Address - Country:US
Mailing Address - Phone:954-516-9685
Mailing Address - Fax:
Practice Address - Street 1:430 SW 182ND WAY
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-4317
Practice Address - Country:US
Practice Address - Phone:954-516-9685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1154720142Medicaid