Healthcare Provider Details

I. General information

NPI: 1871250886
Provider Name (Legal Business Name): BEHAVIORAL FOR KIDS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5729 NW 151ST ST STE B
MIAMI LAKES FL
33014-2481
US

IV. Provider business mailing address

5729 NW 151ST ST STE B
MIAMI LAKES FL
33014-2481
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-2655
  • Fax:
Mailing address:
  • Phone: 786-360-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLEN RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-715-6243