Healthcare Provider Details

I. General information

NPI: 1801953278
Provider Name (Legal Business Name): CHILDREN'S CENTER FOR DEVELOPMENT & BEHAVIOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SAWGRASS CORPORATE PKWY SUITE 106
SUNRISE FL
33325-6244
US

IV. Provider business mailing address

440 SAWGRASS CORPORATE PKWY SUITE 106
SUNRISE FL
33325-6244
US

V. Phone/Fax

Practice location:
  • Phone: 954-745-1112
  • Fax:
Mailing address:
  • Phone: 954-745-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE AZEL
Title or Position: CEO
Credential:
Phone: 954-745-1112