Healthcare Provider Details

I. General information

NPI: 1497670368
Provider Name (Legal Business Name): BALART BEHAVIOR ANALYST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 N KROME AVE STE 202
HOMESTEAD FL
33030-6002
US

IV. Provider business mailing address

123 N KROME AVE STE 202
HOMESTEAD FL
33030-6002
US

V. Phone/Fax

Practice location:
  • Phone: 786-626-2616
  • Fax:
Mailing address:
  • Phone: 786-626-2616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: LIDICE M BALART CID
Title or Position: MNGR
Credential:
Phone: 786-626-2616