Healthcare Provider Details

I. General information

NPI: 1861232365
Provider Name (Legal Business Name): PSIA BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 NW 25TH ST STE 101
MIAMI FL
33127-4418
US

IV. Provider business mailing address

114 NW 25TH ST STE 101
MIAMI FL
33127-4418
US

V. Phone/Fax

Practice location:
  • Phone: 786-512-6645
  • Fax:
Mailing address:
  • Phone: 786-512-6645
  • 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: PENELOPE MORAGUES
Title or Position: PRESIDENT
Credential:
Phone: 786-512-6645