Healthcare Provider Details

I. General information

NPI: 1326819566
Provider Name (Legal Business Name): SALAMAN BIRD BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 13TH ST
SAINT CLOUD FL
34769-4124
US

IV. Provider business mailing address

232 ALABAMA AVE
SAINT CLOUD FL
34769-2131
US

V. Phone/Fax

Practice location:
  • Phone: 407-907-1111
  • Fax: 321-219-8680
Mailing address:
  • Phone: 407-452-2536
  • 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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: HARRY SALAMAN BIRD
Title or Position: MANAGER
Credential:
Phone: 407-907-1111