Healthcare Provider Details

I. General information

NPI: 1144137415
Provider Name (Legal Business Name): CGC BEHAVIORAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 W BURKE ST
TAMPA FL
33614-5910
US

IV. Provider business mailing address

3105 W BURKE ST
TAMPA FL
33614-5910
US

V. Phone/Fax

Practice location:
  • Phone: 862-256-9128
  • Fax:
Mailing address:
  • Phone: 862-256-9128
  • 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: CAMILA GARCIA CIMETIERE
Title or Position: BEHAVIORAL ANALYST
Credential: BCBA
Phone: 862-256-9128