Healthcare Provider Details

I. General information

NPI: 1972903524
Provider Name (Legal Business Name): 1ST JPA BEHAVIOR MANAGEMENT CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19001 SW 106TH AVE SUITE C103
CUTLER BAY FL
33157-7669
US

IV. Provider business mailing address

19001 SW 106TH AVE STE C103
CUTLER BAY FL
33157-7669
US

V. Phone/Fax

Practice location:
  • Phone: 786-523-2352
  • Fax: 786-431-4078
Mailing address:
  • Phone: 786-523-2352
  • Fax: 786-431-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateFL

VIII. Authorized Official

Name: AMARILYS PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 786-200-7425