Healthcare Provider Details

I. General information

NPI: 1386090868
Provider Name (Legal Business Name): ELISA BELLIARD BEHAVIOR ASISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2072 S MILITARY TRL SUITE 11
WEST PALM BEACH FL
33415-6419
US

IV. Provider business mailing address

2072 S MILITARY TRAIL SUITE 11
WEST PALM BEACH FL
33415
US

V. Phone/Fax

Practice location:
  • Phone: 561-543-3357
  • Fax:
Mailing address:
  • Phone: 561-543-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number1386090868.
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: