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General NPI Number Information
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NPI Number | 1104332394
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Entity Type | Organization
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Legal Business Name | CREATING A DIFFERENCE LLC
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 12/27/2017
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Provider Practice Location Address
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Address Line | 800 CYPRESS BLVD APT 204
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City | POMPANO BEACH
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State | FL
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Zip | 33069-4078
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Country | US
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Telephone | 786-301-7622
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Fax |
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Provider Business Mailing Address
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Address Line | 43 S POWERLINE RD # 248
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City | POMPANO BEACH
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State | FL
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Zip | 33069-3001
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Country | US
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Telephone | 786-301-7622
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DIANA BENCID
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Credential | MS, BCBA
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Telephone | 786-301-7622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-27747
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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