Healthcare Provider Details

I. General information

NPI: 1336434836
Provider Name (Legal Business Name): BREVARD BEHAVIORAL CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S HARBOR CITY BLVD STE 220
MELBOURNE FL
32901-4901
US

IV. Provider business mailing address

1900 S HARBOR CITY BLVD STE 220
MELBOURNE FL
32901-4901
US

V. Phone/Fax

Practice location:
  • Phone: 321-432-9738
  • Fax: 321-296-7144
Mailing address:
  • Phone: 321-432-9738
  • Fax: 321-296-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: KEVIN CARRARO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 321-544-7684