MEDICARE: AGENCY OF BEHAVIORAL SERVICES CORP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386351310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGENCY OF BEHAVIORAL SERVICES CORP

Provider Business Mailing Address
First Line	:	2977 GOODLETTE-FRANK RD N STE 14
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-4613
Country	:	US
Telephone Number	:	786-468-1087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2977 GOODLETTE-FRANK RD N STE 14
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-4613
Country	:	US
Telephone Number	:	786-468-1087
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARTHA M HERNANDEZ
Credential	:	BCBA
Telephone Number	:	786-468-1087

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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