=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831899152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | M & B THERAPY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2023
-----------------------------------------------------
Last Update Date | 03/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23842 SW 106TH PL
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-6161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-312-3122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23842 SW 106TH PL
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33032-6161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-312-3122
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BARBARA MARTINEZ GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-312-3122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------