MEDICARE: MERAKI BEHAVIOR THERAPY, 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	:	1336900257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERAKI BEHAVIOR THERAPY, LLC

Provider Business Mailing Address
First Line	:	909 SE 47TH TER STE 201
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9000
Country	:	US
Telephone Number	:	305-812-6561
Fax Number	:	239-899-2148

Provider Business Practice Location Address
First Line	:	909 SE 47TH TER STE 201
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9000
Country	:	US
Telephone Number	:	305-812-6561
Fax Number	:	239-899-2148

Authorized Official
Title or Position	:	OWNER MGR
Name	:	MRS. JESSICA LORENZO
Credential	:	MS, BCBA
Telephone Number	:	305-812-6561

Provider Enumeration Date	:	01/18/2024
Last Update Date	:	06/11/2026

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