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General NPI Number Information
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NPI Number | 1538423595
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Entity Type | Organization
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Legal Business Name | ATTENTION BEHAVIOR COGNITIVE THERAPY CLINIC
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 5720 SW 195TH TER
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City | SOUTHWEST RANCHES
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State | FL
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Zip | 33332-1204
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Country | US
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Telephone | 954-775-5013
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Fax | 800-952-2030
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Provider Business Mailing Address
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Address Line | 45 NW 8TH ST SUITE #102
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City | HOMESTEAD
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State | FL
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Zip | 33030-4452
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Country | US
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Telephone | 305-600-0651
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Fax | 800-952-2030
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYDIA D REID
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Credential | SLP.D
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Telephone | 305-600-0651
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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 | SA 4876
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License Number State | FL
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