Healthcare Provider Details

I. General information

NPI: 1144882598
Provider Name (Legal Business Name): SMART ENDEAVORS ABA, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2019
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 SE 47TH ST STE 218
CAPE CORAL FL
33904-9679
US

IV. Provider business mailing address

2021 EVEREST PKWY
CAPE CORAL FL
33904-3289
US

V. Phone/Fax

Practice location:
  • Phone: 239-268-8707
  • Fax: 239-567-5878
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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANELLE M GARCIA
Title or Position: OWNER
Credential:
Phone: 239-888-9696