Healthcare Provider Details

I. General information

NPI: 1497347272
Provider Name (Legal Business Name): CHILD BEHAVIOR CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

897 TOWNE CENTER DR STE 101
KISSIMMEE FL
34759-3473
US

IV. Provider business mailing address

3051 MENORCA CT
KISSIMMEE FL
34744-4124
US

V. Phone/Fax

Practice location:
  • Phone: 321-303-4819
  • Fax: 866-532-6911
Mailing address:
  • Phone: 321-303-4819
  • Fax: 866-532-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LOURDES RIVERA-GONZALEZ
Title or Position: PRESIDENT
Credential: ADMIN
Phone: 321-303-4819