Healthcare Provider Details

I. General information

NPI: 1225701089
Provider Name (Legal Business Name): CJA BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 E OAK ST STE 106
KISSIMMEE FL
34744-5834
US

IV. Provider business mailing address

809 E OAK ST STE 106
KISSIMMEE FL
34744-5834
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-9520
  • Fax: 407-483-9551
Mailing address:
  • Phone: 407-483-9520
  • Fax: 407-483-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: SERGIO J APONTE
Title or Position: OWNER
Credential:
Phone: 407-483-9520