Provider Demographics
NPI:1780354910
Name:LIGHTING THE WAY ABA THERAPY
Entity type:Organization
Organization Name:LIGHTING THE WAY ABA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:AYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERO PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:551-482-0141
Mailing Address - Street 1:417 TWIN OAKS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3034
Mailing Address - Country:US
Mailing Address - Phone:551-482-0141
Mailing Address - Fax:
Practice Address - Street 1:417 TWIN OAKS LN
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3034
Practice Address - Country:US
Practice Address - Phone:551-482-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-19
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty