Provider Demographics
NPI:1336719491
Name:ABA THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ABA THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDALLA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:727-742-8697
Mailing Address - Street 1:235 3RD AVE N UNIT 406
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3378
Mailing Address - Country:US
Mailing Address - Phone:727-742-8697
Mailing Address - Fax:
Practice Address - Street 1:13575 58TH ST N STE 235
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3740
Practice Address - Country:US
Practice Address - Phone:727-742-8697
Practice Address - Fax:800-981-5129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017422700Medicaid