Healthcare Provider Details

I. General information

NPI: 1417848813
Provider Name (Legal Business Name): BEHAVIORON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BRYANT ST UNIT 411447
SAN FRANCISCO CA
94141-1780
US

IV. Provider business mailing address

1600 BRYANT ST UNIT 411447
SAN FRANCISCO CA
94141-1780
US

V. Phone/Fax

Practice location:
  • Phone: 321-830-0870
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PROF. DEENA MOUSTAFA
Title or Position: OWNER
Credential:
Phone: 321-830-0870