Healthcare Provider Details

I. General information

NPI: 1417660754
Provider Name (Legal Business Name): MR BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E OAKLAND PARK BLVD STE 109B
OAKLAND PARK FL
33334-4400
US

IV. Provider business mailing address

1400 E OAKLAND PARK BLVD STE 109B
OAKLAND PARK FL
33334-4400
US

V. Phone/Fax

Practice location:
  • Phone: 786-889-4423
  • Fax: 813-547-8889
Mailing address:
  • Phone: 786-889-4423
  • Fax: 813-547-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. MARILEIDYS RIVERO
Title or Position: CEO
Credential:
Phone: 973-342-7852