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General NPI Number Information
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NPI Number | 1275279333
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Entity Type | Organization
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Legal Business Name | PIECE OF MIND BEHAVIORAL CONSULTING
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Dates
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Enumeration Date | 05/10/2022
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Last Update Date | 05/10/2022
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Provider Practice Location Address
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Address Line | 731 SW 8TH ST APT 3
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City | POMPANO BEACH
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State | FL
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Zip | 33060-8479
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Country | US
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Telephone | 954-770-8138
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Fax |
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Provider Business Mailing Address
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Address Line | 731 SW 8TH ST APT 3
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City | POMPANO BEACH
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State | FL
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Zip | 33060-8479
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Country | US
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Telephone | 954-770-8138
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | LUDY FERTILE
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Credential |
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Telephone | 954-770-8138
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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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