Healthcare Provider Details

I. General information

NPI: 1912792862
Provider Name (Legal Business Name): CONNECTION - TRANSDISCIPLINARY THERAPEUTIC SUPPORT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 E NEWPORT CENTER DR STE 103
DEERFIELD BEACH FL
33442-7736
US

IV. Provider business mailing address

1191 E NEWPORT CENTER DR STE 103
DEERFIELD BEACH FL
33442-7736
US

V. Phone/Fax

Practice location:
  • Phone: 954-644-0682
  • Fax: 754-333-4768
Mailing address:
  • Phone: 954-644-0682
  • Fax: 754-333-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDRE DE PAIVA COELHO SOPHIA
Title or Position: MANAGER / OWNER
Credential:
Phone: 954-253-6455