MEDICARE: BEHAVIORAL THERAPY SPECIALIST LLC

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

General Provider Information

NPI Number	:	1457142531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL THERAPY SPECIALIST LLC

Provider Business Mailing Address
First Line	:	381 W 29TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5707
Country	:	US
Telephone Number	:	786-223-0989
Fax Number	:	786-364-0119

Provider Business Practice Location Address
First Line	:	381 W 29TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5707
Country	:	US
Telephone Number	:	786-223-0989
Fax Number	:	786-364-0119

Authorized Official
Title or Position	:	OWNER
Name	:	LESLIE PICALLO
Credential	:
Telephone Number	:	786-223-0989

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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