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General NPI Number Information
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NPI Number | 1891113635
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Entity Type | Individual
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Provider Name | GIOVANNI VENETICO MAT, BCBA
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Gender | Male
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Dates
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Enumeration Date | 03/30/2014
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 13195 SW 134TH ST STE 201
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City | MIAMI
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State | FL
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Zip | 33186-4585
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Country | US
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Telephone | 786-206-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 NE 68TH ST APT 1024
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-1223
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Country | US
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Telephone | 786-696-1967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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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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