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General NPI Number Information
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NPI Number | 1396063343
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Entity Type | Organization
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Legal Business Name | MESTRE BEHAVIOR DEVELOPMENT, LLC
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Dates
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Enumeration Date | 05/13/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 6601 SW 80TH ST SUITE 107
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4661
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Country | US
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Telephone | 305-668-8644
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Fax | 305-675-7677
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Provider Business Mailing Address
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Address Line | PO BOX 165054
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City | MIAMI
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State | FL
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Zip | 33116-5054
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Country | US
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Telephone | 305-668-8644
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Fax | 305-675-7677
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY MESTRE
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Credential | M.S., BCBA
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Telephone | 305-668-8644
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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 | 1-09-5030
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License Number State | FL
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