MEDICARE: NEURODIVERSITY MOVEMENT 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	:	1609726389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEURODIVERSITY MOVEMENT LLC

Provider Business Mailing Address
First Line	:	6441 NW 58TH TER
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33067-4438
Country	:	US
Telephone Number	:	561-797-6383
Fax Number	:

Provider Business Practice Location Address
First Line	:	6441 NW 58TH TER
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33067-4438
Country	:	US
Telephone Number	:	561-797-6383
Fax Number	:

Authorized Official
Title or Position	:	BEHAVIOR ANALYST
Name	:	DIANA PUENTES
Credential	:	MS, BCBA
Telephone Number	:	561-797-6383

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	03/05/2026

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