Healthcare Provider Details

I. General information

NPI: 1982133328
Provider Name (Legal Business Name): KIDS CORNER BEHAVIOR SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 COMMERCE CENTER DR
SAINT CLOUD FL
34769-1549
US

IV. Provider business mailing address

311 COMMERCE CENTER DR
SAINT CLOUD FL
34769-1549
US

V. Phone/Fax

Practice location:
  • Phone: 407-201-6255
  • Fax: 407-989-4040
Mailing address:
  • Phone: 407-989-4040
  • Fax: 407-989-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name: LACEY LINAJA
Title or Position: DIRECTOR
Credential:
Phone: 352-872-4098