Healthcare Provider Details

I. General information

NPI: 1801751904
Provider Name (Legal Business Name): ELEVATED BEHAVIOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 HAMPTON CHASE LN
SANFORD FL
32771-4820
US

IV. Provider business mailing address

3855 HAMPTON CHASE LN
SANFORD FL
32771-4820
US

V. Phone/Fax

Practice location:
  • Phone: 516-633-5041
  • Fax:
Mailing address:
  • Phone: 516-633-5041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER AGOSTO
Title or Position: SMLLC
Credential: BCBA
Phone: 516-633-5041