Healthcare Provider Details

I. General information

NPI: 1205213345
Provider Name (Legal Business Name): CHANGING BEHAVIOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2741 EXECUTIVE PARK DR STE 4
WESTON FL
33331-3641
US

IV. Provider business mailing address

16557 SW 52ND ST
MIAMI FL
33185-5168
US

V. Phone/Fax

Practice location:
  • Phone: 786-971-8282
  • Fax:
Mailing address:
  • Phone: 305-588-9359
  • 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: CELISABEL CALDEVILLA
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 305-588-9359