Healthcare Provider Details

I. General information

NPI: 1144844101
Provider Name (Legal Business Name): BEHAVIORAL ASSISTANCE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102025 OVERSEAS HWY UNIT 3
KEY LARGO FL
33037-4521
US

IV. Provider business mailing address

15701 PALMETTO CLUB DR
MIAMI FL
33157-1756
US

V. Phone/Fax

Practice location:
  • Phone: 305-506-4636
  • Fax:
Mailing address:
  • Phone: 786-346-2277
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: REINA RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-346-2277