Healthcare Provider Details

I. General information

NPI: 1144064916
Provider Name (Legal Business Name): CREO EN TI THERAPEUTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 VAN BUREN ST
HOLLYWOOD FL
33021-6723
US

IV. Provider business mailing address

4100 VAN BUREN ST
HOLLYWOOD FL
33021-6723
US

V. Phone/Fax

Practice location:
  • Phone: 786-759-7572
  • Fax:
Mailing address:
  • Phone: 786-759-7572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ARLIETY SUSANA PEREZ
Title or Position: PRESIDENT/ANALYST
Credential: BCBA/LMFT
Phone: 786-759-7572