Healthcare Provider Details

I. General information

NPI: 1871371237
Provider Name (Legal Business Name): SPECTRUM BEHAVIOR THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 SARANAC AVE
WEST PALM BEACH FL
33409-4930
US

IV. Provider business mailing address

3429 SARANAC AVE
WEST PALM BEACH FL
33409-4930
US

V. Phone/Fax

Practice location:
  • Phone: 786-856-8370
  • Fax:
Mailing address:
  • Phone: 786-856-8370
  • 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: ANA MARIA RODRIGUEZ JO
Title or Position: MGR
Credential: RBT-23-295645
Phone: 786-856-8370