Provider Demographics
NPI:1346031879
Name:ADVANCE ABA & PSYCHOTEREAPHY SERVICES, LLC.
Entity type:Organization
Organization Name:ADVANCE ABA & PSYCHOTEREAPHY SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR
Authorized Official - Prefix:
Authorized Official - First Name:LIODANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-674-4357
Mailing Address - Street 1:2808 58TH ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-5802
Mailing Address - Country:US
Mailing Address - Phone:561-674-4357
Mailing Address - Fax:
Practice Address - Street 1:2808 58TH ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-5802
Practice Address - Country:US
Practice Address - Phone:561-674-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty