Healthcare Provider Details

I. General information

NPI: 1316708563
Provider Name (Legal Business Name): KAYCIE LOGAN ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 VILLAGE BLVD
WEST PALM BEACH FL
33407-7907
US

IV. Provider business mailing address

5205 VILLAGE BLVD
WEST PALM BEACH FL
33407-7907
US

V. Phone/Fax

Practice location:
  • Phone: 786-269-1409
  • Fax:
Mailing address:
  • Phone: 786-269-1409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-87792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: