Provider Demographics
NPI:1407377229
Name:FAMILY ABA, LLC
Entity type:Organization
Organization Name:FAMILY ABA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:618-803-0843
Mailing Address - Street 1:421 BEDFORD STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420
Mailing Address - Country:US
Mailing Address - Phone:617-803-0843
Mailing Address - Fax:
Practice Address - Street 1:421 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1536
Practice Address - Country:US
Practice Address - Phone:617-803-0843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124201488OtherASD