Healthcare Provider Details

I. General information

NPI: 1346828977
Provider Name (Legal Business Name): MR. BRADLEY FARIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4163 NW FEDERAL HWY STE 22CD
JENSEN BEACH FL
34957-3623
US

IV. Provider business mailing address

542 AMHERST ST STE B
NASHUA NH
03063-1016
US

V. Phone/Fax

Practice location:
  • Phone: 772-233-9385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88357
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-161729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: