Healthcare Provider Details

I. General information

NPI: 1063910362
Provider Name (Legal Business Name): 4KIDS BEHAVIOR THERAPY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14850 SW 26TH ST STE 104
MIAMI FL
33185-5928
US

IV. Provider business mailing address

14850 SW 26TH ST STE 104
MIAMI FL
33185-5928
US

V. Phone/Fax

Practice location:
  • Phone: 786-516-4316
  • Fax:
Mailing address:
  • Phone: 786-516-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ERNESTO CAMILO SARABIA
Title or Position: PRESIDENT
Credential:
Phone: 786-516-4316