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NPI Code Detail

MEDICARE: CHILDRENS BEHAVIOR THERAPY INC

MEDICARE: CHILDRENS BEHAVIOR THERAPY 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
1252Y00000XEarly Intervention Provider Agency1-15-21107FL
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1215468715
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDRENS BEHAVIOR THERAPY INC
Provider Business Mailing Address
First Line : 8200 NW 41ST ST STE 200
Second Line :
City : DORAL
State : FL
Zip : 33166-6204
Country : US
Telephone Number : 305-401-5259
Fax Number :
Provider Business Practice Location Address
First Line : 7971 RIVIERA BLVD STE 106
Second Line :
City : MIRAMAR
State : FL
Zip : 33023-6446
Country : US
Telephone Number : 305-401-5259
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MRS. VANESSA BOLANOS FERNANDEZ
Credential : BCBA
Telephone Number : 305-401-5259
Provider Enumeration Date : 03/26/2017
Last Update Date : 05/05/2026

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Directions to “CHILDRENS BEHAVIOR THERAPY INC ” Practice Location

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