Provider Demographics
NPI:1740990498
Name:ABA BUDDIES, LLC
Entity type:Organization
Organization Name:ABA BUDDIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YORDANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEZAWI
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-202-1701
Mailing Address - Street 1:24298 SW 113TH PSGE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-7108
Mailing Address - Country:US
Mailing Address - Phone:786-202-1701
Mailing Address - Fax:305-549-0084
Practice Address - Street 1:2901 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2824
Practice Address - Country:US
Practice Address - Phone:305-631-1284
Practice Address - Fax:305-549-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112619000Medicaid