Healthcare Provider Details

I. General information

NPI: 1194392514
Provider Name (Legal Business Name): SIDE BY SIDE BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 CONSULATE DR STE 11
ORLANDO FL
32837-8806
US

IV. Provider business mailing address

2151 CONSULATE DR STE 11
ORLANDO FL
32837-8806
US

V. Phone/Fax

Practice location:
  • Phone: 321-444-9527
  • Fax: 407-641-9591
Mailing address:
  • Phone: 321-444-9527
  • Fax: 407-641-9591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: PAULA NUNEZ GALETTO
Title or Position: BCBA
Credential:
Phone: 321-444-9527