Healthcare Provider Details

I. General information

NPI: 1700585858
Provider Name (Legal Business Name): FIDELITY BEHAVIORAL ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 QUANTUM LAKES DR STE 203
BOYNTON BEACH FL
33426-8323
US

IV. Provider business mailing address

2500 QUANTUM LAKES DR STE 203
BOYNTON BEACH FL
33426-8323
US

V. Phone/Fax

Practice location:
  • Phone: 561-463-0913
  • Fax:
Mailing address:
  • Phone: 561-463-0913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. DLAUREN N MONDESIR
Title or Position: BCBA
Credential: ED.D.
Phone: 561-463-0913