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General NPI Number Information
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NPI Number | 1811487705
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Entity Type | Organization
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Legal Business Name | INNOVATIVE MINDS ABA
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Dates
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Enumeration Date | 05/16/2018
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 8848 SW 211TH LN
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City | CUTLER BAY
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State | FL
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Zip | 33189
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Country | US
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Telephone | 305-321-7817
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Fax |
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Provider Business Mailing Address
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Address Line | 8848 SW 211TH LN
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City | CUTLER BAY
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State | FL
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Zip | 33189-3124
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Country | US
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Telephone | 305-321-7817
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SUZETTE FRAGINALS
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Credential | ED.S
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Telephone | 305-321-7817
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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 | FL
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT15768
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License Number State | FL
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