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General NPI Number Information
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NPI Number | 1215468715
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Entity Type | Organization
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Legal Business Name | CHILDRENS BEHAVIOR THERAPY INC
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Dates
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Enumeration Date | 03/26/2017
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 8200 NW 41ST ST STE 200
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City | DORAL
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State | FL
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Zip | 33166-6204
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Country | US
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Telephone | 305-401-5259
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 NW 41ST ST STE 200
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City | DORAL
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State | FL
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Zip | 33166-6204
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Country | US
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Telephone | 305-401-5259
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. VANESSA BOLANOS FERNANDEZ
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Credential | BCBA
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Telephone | 305-401-5259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1-15-21107
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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