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General NPI Number Information
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NPI Number | 1366390098
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Entity Type | Organization
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Legal Business Name | SPACEKIDS BEHAVIORAL THERAPY, LLC.
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Dates
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Enumeration Date | 03/18/2026
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Last Update Date | 03/18/2026
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Provider Practice Location Address
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Address Line | 15315 NW 60TH AVE STE J
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2496
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Country | US
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Telephone | 305-705-7702
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Fax | 877-420-7488
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Provider Business Mailing Address
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Address Line | 15315 NW 60TH AVE STE J
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2496
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Country | US
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Telephone | 305-705-7702
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Fax | 877-420-7488
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Authorized Official
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Title or Position | MANAGER
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Name | PAULA P GONZALEZ
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Credential |
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Telephone | 305-417-1535
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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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