Healthcare Provider Details

I. General information

NPI: 1306202940
Provider Name (Legal Business Name): BREAKTHROUGH BEHAVIOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12702 SCIENCE DR
ORLANDO FL
32826-3016
US

IV. Provider business mailing address

2301 MAITLAND CENTER PKWY STE 240
MAITLAND FL
32751-7415
US

V. Phone/Fax

Practice location:
  • Phone: 407-574-4629
  • Fax:
Mailing address:
  • Phone: 407-574-4629
  • Fax: 407-965-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. MAEGEN CHRISTINE PIERCE
Title or Position: CEO
Credential: BCBA
Phone: 407-574-4631