Healthcare Provider Details

I. General information

NPI: 1063292514
Provider Name (Legal Business Name): E&T BEHAVIORAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 SW 188TH ST
MIAMI FL
33177-3043
US

IV. Provider business mailing address

12800 SW 188TH ST
MIAMI FL
33177-3043
US

V. Phone/Fax

Practice location:
  • Phone: 786-246-4594
  • Fax:
Mailing address:
  • Phone: 786-246-4594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TANIA RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 786-246-4594