Healthcare Provider Details

I. General information

NPI: 1891528402
Provider Name (Legal Business Name): MYLILYPAD ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3570 ALTIS CIR N UNIT 9105
HIALEAH FL
33018-6081
US

IV. Provider business mailing address

3570 ALTIS CIR N UNIT 9105
HIALEAH FL
33018-6081
US

V. Phone/Fax

Practice location:
  • Phone: 305-778-3079
  • Fax:
Mailing address:
  • Phone: 305-778-3079
  • 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 Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DAYALIN IZQUIERDO
Title or Position: BCBA/OWNER
Credential: BCBA
Phone: 305-778-3079