MEDICARE: KIDS BEHAVIORAL NETWORK, LLC

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1013530096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS BEHAVIORAL NETWORK, LLC

Provider Business Mailing Address
First Line	:	11390 SW 21ST ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6633
Country	:	US
Telephone Number	:	786-333-9275
Fax Number	:

Provider Business Practice Location Address
First Line	:	11390 SW 21ST ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6633
Country	:	US
Telephone Number	:	786-333-9275
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS JENNY COELLO
Credential	:	M.S., LMHC, BCBA
Telephone Number	:	786-333-2975

Provider Enumeration Date	:	05/25/2020
Last Update Date	:	02/06/2026

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