Healthcare Provider Details

I. General information

NPI: 1316422215
Provider Name (Legal Business Name): BREAKTHROUGH BEHAVIOR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 MAITLAND SUMMIT BLVD
ORLANDO FL
32810-5915
US

IV. Provider business mailing address

8701 MAITLAND SUMMIT BLVD
ORLANDO FL
32810-5915
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MAEGEN CHRISTINE PIERCE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-574-4629