Healthcare Provider Details

I. General information

NPI: 1740197243
Provider Name (Legal Business Name): COASTAL KIDS THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 FRONT ST STE 300
JUPITER FL
33477-5095
US

IV. Provider business mailing address

110 FRONT ST STE 300
JUPITER FL
33477-5095
US

V. Phone/Fax

Practice location:
  • Phone: 561-216-9914
  • Fax: 561-831-6688
Mailing address:
  • Phone: 561-216-9914
  • Fax: 561-831-6688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUSEL BENITEZ BARZAGA
Title or Position: PRESIDENT
Credential:
Phone: 561-216-9914