Healthcare Provider Details

I. General information

NPI: 1457112583
Provider Name (Legal Business Name): ALIA FACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 W ATLANTIC AVE STE 110
DELRAY BEACH FL
33484-8103
US

IV. Provider business mailing address

17950 GRIFFIN RD
SOUTHWEST RANCHES FL
33331-1000
US

V. Phone/Fax

Practice location:
  • Phone: 561-900-5145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24359173
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: