Healthcare Provider Details

I. General information

NPI: 1164960027
Provider Name (Legal Business Name): OSCEOLA COUNTY CENTER FOR BEHAVIOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2017
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3282 GREENWALD WAY N
KISSIMMEE FL
34741-0728
US

IV. Provider business mailing address

3282 GREENWALD WAY N
KISSIMMEE FL
34741-0728
US

V. Phone/Fax

Practice location:
  • Phone: 321-355-3904
  • Fax: 407-255-6429
Mailing address:
  • Phone: 321-355-3904
  • Fax: 407-255-6429

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

VIII. Authorized Official

Name: MICHAEL ROBERT SIRAVO
Title or Position: OWNER
Credential: MS, BCBA
Phone: 321-355-3904