Healthcare Provider Details

I. General information

NPI: 1972211621
Provider Name (Legal Business Name): DIRECT BEHAVIORAL SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 NW 181ST ST
HIALEAH FL
33015-2637
US

IV. Provider business mailing address

8201 NW 181ST ST
HIALEAH FL
33015-2637
US

V. Phone/Fax

Practice location:
  • Phone: 305-879-5458
  • Fax:
Mailing address:
  • Phone: 305-879-5458
  • 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 Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAROLINE GARCIA
Title or Position: OWNER
Credential: BCBA
Phone: 305-879-5458