Provider Demographics
NPI:1215427638
Name:ABRACADABRA ABA PLLC
Entity type:Organization
Organization Name:ABRACADABRA ABA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYTYSHA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:321-536-8373
Mailing Address - Street 1:1737 CROGHAN DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6014
Mailing Address - Country:US
Mailing Address - Phone:321-536-8373
Mailing Address - Fax:
Practice Address - Street 1:1737 CROGHAN DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6014
Practice Address - Country:US
Practice Address - Phone:321-536-8373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-16-23127103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty