Healthcare Provider Details

I. General information

NPI: 1811759764
Provider Name (Legal Business Name): JCCA BEHAVIOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13820 LAKE CLAIRE CT
MIAMI LAKES FL
33014-3030
US

IV. Provider business mailing address

13820 LAKE CLAIRE CT
MIAMI LAKES FL
33014-3030
US

V. Phone/Fax

Practice location:
  • Phone: 305-901-5576
  • Fax: 305-363-4555
Mailing address:
  • Phone: 305-901-5576
  • Fax: 305-363-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANAY BRITO
Title or Position: PRESIDENT
Credential: MS
Phone: 305-901-5576