Healthcare Provider Details

I. General information

NPI: 1972215457
Provider Name (Legal Business Name): WDM BEHAVIOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2022
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12460 SW 22ND TER
MIAMI FL
33175-7703
US

IV. Provider business mailing address

12460 SW 22ND TER
MIAMI FL
33175-7703
US

V. Phone/Fax

Practice location:
  • Phone: 786-348-1159
  • Fax:
Mailing address:
  • Phone: 786-348-1159
  • 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: YILIAN WONG
Title or Position: CEO
Credential:
Phone: 786-348-1159