Basic Information
| Provider Information | |||||||||
| NPI: | 1588227029 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL COAST ABA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1957 ARCADIA CT | ||||||||
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| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939065415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086881373 | ||||||||
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| Address1: | 1957 ARCADIA CT | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939065415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4086881373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2019 | ||||||||
| LastUpdateDate: | 04/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | BARBOSA | ||||||||
| AuthorizedOfficialFirstName: | MARISOL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8314555546 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.