=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346782091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEHAVIORAL INTERVENTION FOR AUTISM, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2016
-----------------------------------------------------
Last Update Date | 11/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 KNUTH RD STE 230
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33436-4637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 156-196-2128
-----------------------------------------------------
Fax | 561-375-9299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 KNUTH RD STE 230
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33436-4637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 156-196-2128
-----------------------------------------------------
Fax | 561-375-9299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LISA SLOTNICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-962-1284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------