Healthcare Provider Details

I. General information

NPI: 1992233449
Provider Name (Legal Business Name): FULL SPECTRUM INTEGRATED EDUCATIONAL SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BRICKELL KEY BLVD APT 2007
MIAMI FL
33131-3718
US

IV. Provider business mailing address

801 BRICKELL KEY BLVD APT 2007
MIAMI FL
33131-3718
US

V. Phone/Fax

Practice location:
  • Phone: 561-302-9353
  • Fax:
Mailing address:
  • Phone: 561-302-9353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHLOE CAVAYERO
Title or Position: OWNER
Credential: BCBA
Phone: 561-302-9353