Healthcare Provider Details

I. General information

NPI: 1922527613
Provider Name (Legal Business Name): EQUANIMITY BEHAVIORAL SERVICES CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14359 MIRAMAR PKWY SUITE 504
MIRAMAR FL
33027
US

IV. Provider business mailing address

14359 MIRAMAR PKWY STE 504
MIRAMAR FL
33027-4134
US

V. Phone/Fax

Practice location:
  • Phone: 650-213-2283
  • Fax:
Mailing address:
  • Phone: 650-213-2283
  • 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 Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KELLY DAYANA NEGRON
Title or Position: PRESIDENT
Credential: D.H.SCI, ITDS
Phone: 650-213-2283