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General NPI Number Information
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NPI Number | 1417660754
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Entity Type | Organization
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Legal Business Name | MR BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 01/02/2023
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 1380 NE MIAMI GARDENS DR STE 142
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City | MIAMI
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State | FL
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Zip | 33179-4744
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Country | US
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Telephone | 973-342-7852
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Fax | 813-547-8889
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Provider Business Mailing Address
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Address Line | 1380 NE MIAMI GARDENS DR STE 142
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City | MIAMI
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State | FL
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Zip | 33179-4744
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Country | US
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Telephone |
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Fax | 813-547-8889
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Authorized Official
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Title or Position | CEO
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Name | MS. MARILEIDYS RIVERO
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Credential |
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Telephone | 973-342-7852
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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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