Healthcare Provider Details
I. General information
NPI: 1184435646
Provider Name (Legal Business Name): SUNNYSIDE BEHAVIORAL HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/15/2025
Last Update Date: 03/14/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
370 MAIN ST
WORCESTER MA
01608-1723
US
IV. Provider business mailing address
3275 DUNNING DR
ROYAL PALM BEACH FL
33411-8317
US
V. Phone/Fax
- Phone: 305-713-8093
- Fax:
- Phone: 305-713-8093
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 106S00000X |
| Taxonomy | Behavior Technician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
BRUNA
OROZ FOGLIANO
Title or Position: PRESIDENT
Credential: BCBA LBA
Phone: 305-713-8093