MEDICARE: SMART BEHAVIORAL INNOVATION 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	103K00000X	Behavior Analyst

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	:	1760120596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART BEHAVIORAL INNOVATION CORP

Provider Business Mailing Address
First Line	:	1202 SACRAMENTO ST
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-8420
Country	:	US
Telephone Number	:	386-400-2326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 SACRAMENTO ST FL 32725
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-8420
Country	:	US
Telephone Number	:	386-400-2326
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	NESTOR I FONSECA ALVAREZ
Credential	:
Telephone Number	:	386-400-2326

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	02/11/2026

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