Provider Demographics
NPI:1144938564
Name:SUPERSONIC ABA LLC
Entity type:Organization
Organization Name:SUPERSONIC ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA, COBA
Authorized Official - Phone:317-225-9119
Mailing Address - Street 1:22600 ASCOA CT
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-4700
Mailing Address - Country:US
Mailing Address - Phone:216-260-4847
Mailing Address - Fax:
Practice Address - Street 1:22600 ASCOA CT
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-4700
Practice Address - Country:US
Practice Address - Phone:216-260-4847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty