MEDICARE: SMART BEHAVIORAL HEALTH 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

General Provider Information

NPI Number	:	1780552448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART BEHAVIORAL HEALTH CORP

Provider Business Mailing Address
First Line	:	1640 HIGHLAND DR
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4534
Country	:	US
Telephone Number	:	386-400-2326
Fax Number	:	286-401-2342

Provider Business Practice Location Address
First Line	:	1640 HIGHLAND DR
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4534
Country	:	US
Telephone Number	:	305-298-2123
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	NESTOR FONSECA
Credential	:
Telephone Number	:	305-298-2123

Provider Enumeration Date	:	10/24/2025
Last Update Date	:	01/20/2026

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Directions to “SMART BEHAVIORAL HEALTH CORP ” Practice Location

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