Healthcare Provider Details

I. General information

NPI: 1649989773
Provider Name (Legal Business Name): CHANGING BEHAVIORS & LIVES ABA THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 SW 162ND PATH
MIAMI FL
33193-4469
US

IV. Provider business mailing address

6503 SW 162ND PATH
MIAMI FL
33193-4469
US

V. Phone/Fax

Practice location:
  • Phone: 305-467-2240
  • Fax:
Mailing address:
  • Phone: 305-467-2240
  • 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 Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH QUEVEDO
Title or Position: BEHAVIOR ANALYST
Credential: BCBA
Phone: 305-467-2240