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General NPI Number Information
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NPI Number | 1609642016
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Entity Type | Organization
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Legal Business Name | LASTING BEHAVIOR CHANGES
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 8461 LAKE WORTH RD STE 150
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City | LAKE WORTH
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State | FL
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Zip | 33467-2474
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Country | US
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Telephone | 561-714-7042
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 LANTANA RD APT 3206
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City | LAKE WORTH
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State | FL
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Zip | 33462-0925
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Country | US
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Telephone | 561-713-8258
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Fax |
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Authorized Official
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Title or Position | BCBA
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Name | YENISEY FERNANDEZ
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Credential |
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Telephone | 561-315-4170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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