MEDICARE: ELISA BELLIARD BEHAVIOR ASISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		FL
2	247200000X	Other Technician	1386090868.	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386090868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA BELLIARD BEHAVIOR ASISTANT

Provider Business Mailing Address
First Line	:	2072 S MILITARY TRAIL
Second Line	:	SUITE 11
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415
Country	:	US
Telephone Number	:	561-543-3357
Fax Number	:

Provider Business Practice Location Address
First Line	:	2072 S MILITARY TRL
Second Line	:	SUITE 11
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-6419
Country	:	US
Telephone Number	:	561-543-3357
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2016
Last Update Date	:	05/23/2016

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