Healthcare Provider Details

I. General information

NPI: 1497913214
Provider Name (Legal Business Name): BEHAVIOR BASICS, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1887 SE PORT ST LUCIE BLVD
PORT ST LUCIE FL
34952-5530
US

IV. Provider business mailing address

1887 SW PINEWOOD WAY
PALM CITY FL
34990-1363
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-0444
  • Fax: 772-219-1339
Mailing address:
  • Phone: 321-431-7352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1010577
License Number StateFL

VIII. Authorized Official

Name: KARIN TORSIELLO
Title or Position: PRESIDENT
Credential: MS
Phone: 321-431-7352