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General NPI Number Information
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NPI Number | 1962900167
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Entity Type | Organization
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Legal Business Name | MINDGARDEN THERAPY CENTER CORP
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 15250 DURNFORD DR
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2328
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Country | US
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Telephone | 786-717-8011
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Fax |
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Provider Business Mailing Address
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Address Line | 801 W 50TH ST
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City | HIALEAH
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State | FL
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Zip | 33012-3413
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Country | US
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Telephone | 786-717-8011
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANAY BENCOMO
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Credential |
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Telephone | 786-717-8011
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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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