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General NPI Number Information
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NPI Number | 1225810674
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Entity Type | Organization
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Legal Business Name | MBC BEHAVIOR ANALYSIS LLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 12392 SW 82ND AVE # 12392A
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City | PINECREST
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State | FL
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Zip | 33156-5223
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Country | US
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Telephone | 786-302-3814
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Fax |
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Provider Business Mailing Address
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Address Line | 12392 SW 82ND AVE # 12392-A
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City | PINECREST
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State | FL
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Zip | 33156-5223
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Country | US
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Telephone | 786-302-3814
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MAYLEN BALART CID
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Credential | BCBA
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Telephone | 786-553-3846
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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 |
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License Number State |
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