MEDICARE: CHILDRENS DREAM SUPPORT 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

General Provider Information

NPI Number	:	1417706433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS DREAM SUPPORT CORP

Provider Business Mailing Address
First Line	:	5901 MIAMI GARDENS DR STE 207
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-6007
Country	:	US
Telephone Number	:	786-560-3178
Fax Number	:	305-882-9911

Provider Business Practice Location Address
First Line	:	5901 MIAMI GARDENS DR STE 207
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-6007
Country	:	US
Telephone Number	:	786-560-3178
Fax Number	:	305-882-9911

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KATILEIDIS ALFARO TIELES
Credential	:
Telephone Number	:	786-560-3178

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	10/09/2025

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Directions to “CHILDRENS DREAM SUPPORT CORP ” Practice Location

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