Provider Demographics
NPI:1851123228
Name:WISE ABA LLC
Entity type:Organization
Organization Name:WISE ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGUNA
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:754-422-7316
Mailing Address - Street 1:14655 VIA TIVOLI CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6917
Mailing Address - Country:US
Mailing Address - Phone:754-422-7316
Mailing Address - Fax:
Practice Address - Street 1:303 SW 6TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-1027
Practice Address - Country:US
Practice Address - Phone:754-422-7316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty