Healthcare Provider Details

I. General information

NPI: 1528648474
Provider Name (Legal Business Name): LOVE FOR CHILDHOOD BEHAVIORAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 N KILLIAN DR STE 206C
LAKE PARK FL
33403-1961
US

IV. Provider business mailing address

1408 N KILLIAN DR STE 206C
LAKE PARK FL
33403-1961
US

V. Phone/Fax

Practice location:
  • Phone: 786-307-3571
  • Fax: 305-709-1956
Mailing address:
  • Phone: 786-307-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: JOSE L FANJUL RIVERO
Title or Position: PRESIDENT
Credential:
Phone: 786-307-3571