Healthcare Provider Details

I. General information

NPI: 1942814991
Provider Name (Legal Business Name): QUALITY BEHAVIOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2020
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 ORANOLE RD
ORLANDO FL
32810-2017
US

IV. Provider business mailing address

3104 ORANOLE RD
ORLANDO FL
32810-2017
US

V. Phone/Fax

Practice location:
  • Phone: 407-501-0494
  • Fax:
Mailing address:
  • Phone:
  • 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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: YANEYSI GARCIA
Title or Position: MANAGER
Credential:
Phone: 407-501-0494