Healthcare Provider Details

I. General information

NPI: 1861815383
Provider Name (Legal Business Name): MARIA PRESTON BEHAVIOR ANALYST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 LAKE POINT DR
WESTON FL
33326-2356
US

IV. Provider business mailing address

1925 LAKE POINT DR
WESTON FL
33326-2356
US

V. Phone/Fax

Practice location:
  • Phone: 954-401-2024
  • Fax:
Mailing address:
  • Phone: 954-401-2024
  • Fax: 954-434-1741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: