=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710562590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAYMO BEHAVORIAL SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2021
-----------------------------------------------------
Last Update Date | 04/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7360 SW 24TH ST STE 22A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-1482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-307-5409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7360 SW 24TH ST STE 22A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-1482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-307-5409
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YIPSY LEONOR MARANTE SANTOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-307-5409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------