Healthcare Provider Details

I. General information

NPI: 1083119101
Provider Name (Legal Business Name): FAMILY BEHAVIOR AND THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 E 51ST PL
HIALEAH FL
33013-1447
US

IV. Provider business mailing address

11 E 51ST PL
HIALEAH FL
33013-1447
US

V. Phone/Fax

Practice location:
  • Phone: 786-553-4365
  • Fax:
Mailing address:
  • Phone: 786-553-4365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NIUBIS GARCIA
Title or Position: OWNER
Credential:
Phone: 786-553-4365