MEDICARE: VOCATIONAL DEVELOPMENT GROUP, 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	:	1336812304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOCATIONAL DEVELOPMENT GROUP, LLC

Provider Business Mailing Address
First Line	:	6416 NW 5TH WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:	954-982-6491

Provider Business Practice Location Address
First Line	:	1000 COLOUR PL STE 101
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-7753
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:	954-982-6491

Authorized Official
Title or Position	:	CONTRACTING DIRECTOR
Name	:	KATE RAGER
Credential	:
Telephone Number	:	954-329-2678

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	07/27/2021

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