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General NPI Number Information
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NPI Number | 1922527613
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Entity Type | Organization
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Legal Business Name | EQUANIMITY BEHAVIORAL SERVICES CO
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14359 MIRAMAR PKWY SUITE 504
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City | MIRAMAR
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State | FL
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Zip | 33027
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Country | US
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Telephone | 650-213-2283
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Fax |
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Provider Business Mailing Address
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Address Line | 14359 MIRAMAR PKWY STE 504
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City | MIRAMAR
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State | FL
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Zip | 33027-4134
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Country | US
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Telephone | 650-213-2283
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KELLY DAYANA NEGRON
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Credential | D.H.SCI, ITDS
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Telephone | 650-213-2283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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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 | 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 #6
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #8
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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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