MEDICARE: THRIVE BEHAVIOR THERAPY

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1376244335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE BEHAVIOR THERAPY

Provider Business Mailing Address
First Line	:	14310 SW 8TH STREET
Second Line	:	P.O. BOX 940194
City	:	MIAMI
State	:	FL
Zip	:	33194
Country	:	US
Telephone Number	:	305-766-3097
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 SW 153RD CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4706
Country	:	US
Telephone Number	:	305-766-3097
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	MRS. AMANDA LIANE RUGAMA LEIVA
Credential	:	MS
Telephone Number	:	305-766-3097

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	03/15/2023

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Directions to “THRIVE BEHAVIOR THERAPY ” Practice Location

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