Healthcare Provider Details

I. General information

NPI: 1558069120
Provider Name (Legal Business Name): NEVERT BARSOUM M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 BIRKDALE DR
WELLINGTON FL
33414-5809
US

IV. Provider business mailing address

12093 REGAL CT W
WELLINGTON FL
33414-5764
US

V. Phone/Fax

Practice location:
  • Phone: 954-552-6668
  • Fax: 954-206-5584
Mailing address:
  • Phone: 561-543-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-82474
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: