Healthcare Provider Details

I. General information

NPI: 1689546632
Provider Name (Legal Business Name): JC KIDS ABA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 NE 12TH AVE LOT 85
HOMESTEAD FL
33030-6230
US

IV. Provider business mailing address

220 NE 12TH AVE LOT 85
HOMESTEAD FL
33030-6230
US

V. Phone/Fax

Practice location:
  • Phone: 561-907-3315
  • Fax:
Mailing address:
  • Phone: 561-907-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOSE CASANOVA
Title or Position: MUSIC THERAPIST
Credential:
Phone: 561-907-3315