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General NPI Number Information
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NPI Number | 1780215665
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Entity Type | Organization
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Legal Business Name | MINDS IN MOTION ABA THERAPY CENTER LLC
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 9070 KIMBERLY BLVD STE 19-20
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City | BOCA RATON
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State | FL
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Zip | 33434-2855
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Country | US
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Telephone | 954-988-0918
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Fax | 954-827-7625
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Provider Business Mailing Address
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Address Line | 9070 KIMBERLY BLVD STE 19-20
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City | BOCA RATON
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State | FL
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Zip | 33434-2855
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Country | US
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Telephone | 954-988-0918
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Fax | 954-827-7625
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Authorized Official
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Title or Position | OWNER
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Name | SUZANNE DIAZ
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Credential |
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Telephone | 917-763-0885
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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 |
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License Number State |
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