Blaze ABA, LLC

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

BLAZE ABA, LLC

Practice address

30192 Armenia Rd
Leesburg, FL 34748-8454

Phone

(239) 465-8663

NPI assigned

Sep 13, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dawenn Dorgile, BCBANPI 1033742739

Title

Owner/Bcba

Phone

(239) 465-8663

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Dawenn Dorgile, BCBA

  • Behavior Analyst
  • Concord, CA
  • NPI 1033742739
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1932935079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30192 ARMENIA RD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347488454",
            "telephone_number": "239-465-8663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30192 ARMENIA RD",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347488454",
            "telephone_number": "239-465-8663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAZE ABA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-13",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "DORGILE",
        "authorized_official_first_name": "DAWENN",
        "authorized_official_title_or_position": "OWNER/BCBA",
        "authorized_official_telephone_number": "239-465-8663",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BCBA"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.