MEDICARE: PSYCHOLOGY AND BEHAVIOR SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013211184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGY AND BEHAVIOR SERVICES

Provider Business Mailing Address
First Line	:	11233 NW 50TH TER
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-3543
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4882 NW 4TH TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-2171
Country	:	US
Telephone Number	:	305-639-3049
Fax Number	:	305-639-3049

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. FRANK DAVID ROSA
Credential	:	PSY.D, BCBA-D
Telephone Number	:	305-801-8957

Provider Enumeration Date	:	01/04/2011
Last Update Date	:	01/04/2011

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Directions to “PSYCHOLOGY AND BEHAVIOR SERVICES ” Practice Location

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