Healthcare Provider Details

I. General information

NPI: 1194617340
Provider Name (Legal Business Name): ANCHORED GROWTH BEHAVIORAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 SW 104TH CT
MIAMI FL
33165-7330
US

IV. Provider business mailing address

1714 SW 104TH CT
MIAMI FL
33165-7330
US

V. Phone/Fax

Practice location:
  • Phone: 305-467-2535
  • Fax:
Mailing address:
  • Phone: 305-467-2535
  • 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: MARVELY MENENDEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-467-2535