Healthcare Provider Details

I. General information

NPI: 1215468715
Provider Name (Legal Business Name): CHILDRENS BEHAVIOR THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7971 RIVIERA BLVD STE 106
MIRAMAR FL
33023-6446
US

IV. Provider business mailing address

8200 NW 41ST ST STE 200
DORAL FL
33166-6204
US

V. Phone/Fax

Practice location:
  • Phone: 305-401-5259
  • Fax:
Mailing address:
  • Phone: 305-401-5259
  • 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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1-15-21107
License Number StateFL

VIII. Authorized Official

Name: MRS. VANESSA BOLANOS FERNANDEZ
Title or Position: PRESIDENT
Credential: BCBA
Phone: 305-401-5259