Healthcare Provider Details

I. General information

NPI: 1417624875
Provider Name (Legal Business Name): JMS BEHAVIOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 02/18/2023
Certification Date: 02/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PONCE DE LEON BLVD APT 704
CORAL GABLES FL
33134-3359
US

IV. Provider business mailing address

1300 PONCE DE LEON BLVD APT 704
CORAL GABLES FL
33134-3359
US

V. Phone/Fax

Practice location:
  • Phone: 786-614-5331
  • Fax:
Mailing address:
  • Phone: 786-614-5331
  • 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: MADELEN MONTANO SILVA
Title or Position: PRESIDENT
Credential: BCBA
Phone: 786-614-5331