Healthcare Provider Details

I. General information

NPI: 1326588781
Provider Name (Legal Business Name): MY BA THERAPY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 PARK PLACE BLVD STE 2
KISSIMMEE FL
34741-2373
US

IV. Provider business mailing address

8378 LUDINGTON CIR
ORLANDO FL
32836-5910
US

V. Phone/Fax

Practice location:
  • Phone: 407-385-0728
  • Fax: 407-386-8988
Mailing address:
  • Phone: 407-352-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CARL DE NOBREGA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 305-910-3247