=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558076604
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SQUARE ONE BEHAVIORAL SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2023
-----------------------------------------------------
Last Update Date | 01/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420 S STATE ROAD 7 STE 174
-----------------------------------------------------
City | ROYAL PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-4306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-568-9367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2221 WHITE PINE CIR APT D
-----------------------------------------------------
City | GREENACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33415-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-667-2181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LEIDA ALARCON
-----------------------------------------------------
Credential | BCBA
-----------------------------------------------------
Telephone | 561-667-2181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------