MEDICARE: EQUIP BEHAVIORAL SERVICES

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	251S00000X	Community/Behavioral Health Agency	L16000053079	FL

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	:	1942651492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUIP BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	14728 ROYAL POINCIANA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7329
Country	:	US
Telephone Number	:	407-416-0810
Fax Number	:

Provider Business Practice Location Address
First Line	:	14728 ROYAL POINCIANA DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7329
Country	:	US
Telephone Number	:	407-416-0810
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/BEHAVIOR ANALYST
Name	:	MR. OLIVER KARL NOFUENTE
Credential	:	M.S.
Telephone Number	:	407-416-0810

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	06/27/2016

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Directions to “EQUIP BEHAVIORAL SERVICES ” Practice Location

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