Healthcare Provider Details

I. General information

NPI: 1811487705
Provider Name (Legal Business Name): INNOVATIVE MINDS ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8848 SW 211TH LN
CUTLER BAY FL
33189
US

IV. Provider business mailing address

8848 SW 211TH LN
CUTLER BAY FL
33189-3124
US

V. Phone/Fax

Practice location:
  • Phone: 305-321-7817
  • Fax:
Mailing address:
  • Phone: 305-321-7817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT15768
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUZETTE FRAGINALS
Title or Position: OWNER
Credential: ED.S
Phone: 305-321-7817