MEDICARE: BRITTOS BEHAVIOR THERAPY CORP

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1528730397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRITTOS BEHAVIOR THERAPY CORP

Provider Business Mailing Address
First Line	:	1160 W 28TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1121
Country	:	US
Telephone Number	:	786-828-8479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 W 28TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1121
Country	:	US
Telephone Number	:	786-828-8479
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GRETER BRITO
Credential	:
Telephone Number	:	786-828-8479

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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