=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063219319
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEI BEHAVIORAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2025
-----------------------------------------------------
Last Update Date | 02/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 560 VILLAGE BLVD STE 120 # 83
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-662-8409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 560 VILLAGE BLVD STE 120 # 83
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-662-8409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JODI FELITTI
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 561-662-8409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------