=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740197243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL KIDS THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2026
-----------------------------------------------------
Last Update Date | 08/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 FRONT ST STE 300
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33477-5095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-216-9914
-----------------------------------------------------
Fax | 561-831-6688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 FRONT ST STE 300
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33477-5095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-216-9914
-----------------------------------------------------
Fax | 561-831-6688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SUSEL BENITEZ BARZAGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-216-9914
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------