MEDICARE: STELLAR STEPS BEHAVIORAL SOLUTIONS

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		FL

General Provider Information

NPI Number	:	1497117352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STELLAR STEPS BEHAVIORAL SOLUTIONS

Provider Business Mailing Address
First Line	:	1365 NE 139TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3430
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 NE 139TH ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33161-3430
Country	:	US
Telephone Number	:	305-297-4277
Fax Number	:

Authorized Official
Title or Position	:	CEO/BEHAVIOR ANALYST
Name	:	MS. MARIE CARMAUDELY LOURDIMIE GALLIOTTE
Credential	:	M.S., BCBA
Telephone Number	:	305-297-4277

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/22/2016

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