Healthcare Provider Details

I. General information

NPI: 1003491044
Provider Name (Legal Business Name): CYNTHIA SHOGREEN BCBA, LPC, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2021
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13195 SW 134TH ST STE 201
MIAMI FL
33186-4585
US

IV. Provider business mailing address

5799 NW WHITECAP RD
PORT ST LUCIE FL
34986-3709
US

V. Phone/Fax

Practice location:
  • Phone: 786-206-6500
  • Fax:
Mailing address:
  • Phone: 786-362-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-54369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: