Healthcare Provider Details

I. General information

NPI: 1275418477
Provider Name (Legal Business Name): FLORIDA SCHOOL BASED BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 N ATLANTIC AVE
COCOA BEACH FL
32931-5213
US

IV. Provider business mailing address

277 VIA DE LA REINA
MERRITT ISLAND FL
32953-2915
US

V. Phone/Fax

Practice location:
  • Phone: 973-883-5175
  • Fax:
Mailing address:
  • Phone: 973-883-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GABRIEL MONTERO
Title or Position: CEO
Credential:
Phone: 973-883-5175