Healthcare Provider Details

I. General information

NPI: 1518530369
Provider Name (Legal Business Name): BEWELL BEHAVIOR THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 N OCEAN DR
RIVIERA BEACH FL
33404-4751
US

IV. Provider business mailing address

2655 N OCEAN DR
RIVIERA BEACH FL
33404-4751
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-6706
  • Fax:
Mailing address:
  • Phone: 305-979-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ARLENIS BOMPART
Title or Position: PRESIDENT
Credential:
Phone: 305-979-6706