# AUTISM BEHAVIOR THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528636750
- **Authorized official:** BONNY LEE BIBEL MA, BCBA (BOARD CERTIFIED BEHAVIOR ANALYST)
- **Authorized official phone:** (689) 308-8057

## Contact information

- **Practice address:** 712 SECRET HARBOR LN UNIT 102, LAKE MARY, FL 32746-6497
- **Practice address phone:** (312) 351-1803
- **Mailing address:** 288 MARJORIE BLVD, LONGWOOD, FL 32750-4627
- **Mailing address phone:** (689) 308-8057
- **Mailing address fax:** (689) 215-0653

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | Yes |
| 103K00000X | Behavior Analyst | — | — | Yes |

## Other

- **Enumeration date:** 06/14/2021
- **Last updated:** 07/02/2024