MEDICARE: ALTERARE ADVANTAGE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	106E00000X	Assistant Behavior Analyst
3	106S00000X	Behavior Technician
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194459891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTERARE ADVANTAGE LLC

Provider Business Mailing Address
First Line	:	2911 STONE GLEN WAY APT 107
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1784
Country	:	US
Telephone Number	:	407-780-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 STONE GLEN WAY APT 107
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-1784
Country	:	US
Telephone Number	:	407-780-0177
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAZZMYN IGLESIA
Credential	:	MS BCBA
Telephone Number	:	407-780-0177

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	07/11/2022

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Directions to “ALTERARE ADVANTAGE LLC ” Practice Location

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