Healthcare Provider Details

I. General information

NPI: 1598463267
Provider Name (Legal Business Name): IC BEHAVIOR SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15315 NW 60TH AVE STE D
MIAMI LAKES FL
33014-2440
US

IV. Provider business mailing address

15315 NW 60TH AVE STE D
MIAMI LAKES FL
33014-2440
US

V. Phone/Fax

Practice location:
  • Phone: 305-978-2972
  • Fax:
Mailing address:
  • Phone: 305-978-2972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ILIANA CAMEJO
Title or Position: OWNER/APRN
Credential: OWNER/APRN
Phone: 305-978-2972