MEDICARE: MISS B'S BEHAVIORAL SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251V00000X	Voluntary or Charitable Agency
2	252Y00000X	Early Intervention Provider Agency
3	343900000X	Non-emergency Medical Transport (VAN)
4	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1164138277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISS B'S BEHAVIORAL SERVICES

Provider Business Mailing Address
First Line	:	4736 34TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-1234
Country	:	US
Telephone Number	:	772-584-6227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1590 9TH ST SW
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-4311
Country	:	US
Telephone Number	:	772-713-4130
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LATOYA M. BULLARD
Credential	:	BA
Telephone Number	:	772-713-4130

Provider Enumeration Date	:	01/24/2023
Last Update Date	:	03/27/2023

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