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General NPI Number Information
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NPI Number | 1386225688
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Entity Type | Organization
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Legal Business Name | PRISM EARLY ADVANCEMENT CENTER 1 LLC
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Dates
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Enumeration Date | 04/19/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 245 CATALONIA AVE
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City | CORAL GABLES
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State | FL
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Zip | 33134-6704
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Country | US
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Telephone | 305-448-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 245 CATALONIA AVE
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City | CORAL GABLES
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State | FL
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Zip | 33134-6704
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CHRISTOPHER MALEK
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Credential |
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Telephone | 305-448-2828
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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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