Healthcare Provider Details

I. General information

NPI: 1467955658
Provider Name (Legal Business Name): MY KID THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 02/23/2023
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N KROME AVE
HOMESTEAD FL
33030
US

IV. Provider business mailing address

1180 N KROME AVE
HOMESTEAD FL
33030-4413
US

V. Phone/Fax

Practice location:
  • Phone: 786-349-4700
  • Fax:
Mailing address:
  • Phone: 786-349-4700
  • 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

VIII. Authorized Official

Name: GRETTEL CASTILLO
Title or Position: PRESIDENT
Credential:
Phone: 786-349-4700