MEDICARE: LG BEHAVIOR ANALYSIS 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	:	1083471460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LG BEHAVIOR ANALYSIS LLC

Provider Business Mailing Address
First Line	:	8000 N FEDERAL HWY STE 207
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-1681
Country	:	US
Telephone Number	:	305-927-0931
Fax Number	:

Provider Business Practice Location Address
First Line	:	8000 N FEDERAL HWY STE 207
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33487-1681
Country	:	US
Telephone Number	:	305-927-0931
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAURA A GOMEZ
Credential	:	BCBA
Telephone Number	:	305-927-0931

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/12/2024

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