MEDICARE: BEHAVIOR ANALYSIS, INC.

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	103TB0200X	Cognitive & Behavioral Psychologist	NA

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

General Provider Information

NPI Number	:	1083824205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIOR ANALYSIS, INC.

Provider Business Mailing Address
First Line	:	8001 SW 36TH ST
Second Line	:	SUITE 9
City	:	DAVIE
State	:	FL
Zip	:	33328-1915
Country	:	US
Telephone Number	:	954-577-7790
Fax Number	:	954-577-7780

Provider Business Practice Location Address
First Line	:	8001 SW 36TH ST
Second Line	:	SUITE 9
City	:	DAVIE
State	:	FL
Zip	:	33328-1915
Country	:	US
Telephone Number	:	954-577-7790
Fax Number	:	954-577-7780

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. SILVIA MARUSSICH
Credential	:	MSW
Telephone Number	:	954-577-7790

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	09/15/2010

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