Healthcare Provider Details

I. General information

NPI: 1477252930
Provider Name (Legal Business Name): MY KID THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 N SEMORAN BLVD STE 207
ORLANDO FL
32807-3555
US

IV. Provider business mailing address

5775 BLUE LAGOON DR STE 325
MIAMI FL
33126-2020
US

V. Phone/Fax

Practice location:
  • Phone: 689-800-2083
  • Fax:
Mailing address:
  • Phone: 786-762-2795
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GRETTEL CASTILLO
Title or Position: PRESIDENT
Credential:
Phone: 786-349-4700