Provider Demographics
NPI:1750103487
Name:VERO BEACH ABA LLC
Entity type:Organization
Organization Name:VERO BEACH ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BORDA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:772-291-6654
Mailing Address - Street 1:1985 FLORA LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-1033
Mailing Address - Country:US
Mailing Address - Phone:772-291-6654
Mailing Address - Fax:
Practice Address - Street 1:1985 FLORA LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1033
Practice Address - Country:US
Practice Address - Phone:772-291-6654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730559808Medicaid