Healthcare Provider Details

I. General information

NPI: 1740571355
Provider Name (Legal Business Name): RISING ABOVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 INDIAN TRCE BOX 641
WESTON FL
33326-2996
US

IV. Provider business mailing address

304 INDIAN TRCE BOX 641
WESTON FL
33326-2996
US

V. Phone/Fax

Practice location:
  • Phone: 800-483-7318
  • Fax: 800-483-7319
Mailing address:
  • Phone: 800-483-7318
  • Fax: 800-483-7319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8039
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number1-11-8039
License Number StateFL

VIII. Authorized Official

Name: MS. TIFFANY VALENCIA LENOIR
Title or Position: BEHAVIOR ANALYST
Credential: BCBA
Phone: 786-312-6415