Healthcare Provider Details

I. General information

NPI: 1336965987
Provider Name (Legal Business Name): KSM BEHAVIORAL INTERVENTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2024
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NW 74TH AVE STE 210
MIAMI FL
33122-1443
US

IV. Provider business mailing address

2801 NW 74TH AVE STE 210
MIAMI FL
33122-1443
US

V. Phone/Fax

Practice location:
  • Phone: 786-970-6385
  • Fax: 786-743-6385
Mailing address:
  • Phone: 786-970-6385
  • Fax: 786-743-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MILEISY GONZALEZ RODRIGUEZ
Title or Position: CEO
Credential: LMHC, MCAP, CBHCMS
Phone: 786-970-6385