MEDICARE: DREAM TEAM BEHAVIORAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician
3	106E00000X	Assistant Behavior Analyst

General Provider Information

NPI Number	:	1497369540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM TEAM BEHAVIORAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	6915 W 2ND WAY
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-5319
Country	:	US
Telephone Number	:	440-320-6543
Fax Number	:	786-226-0641

Provider Business Practice Location Address
First Line	:	6915 W 2ND WAY
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-5319
Country	:	US
Telephone Number	:	440-320-6543
Fax Number	:	786-226-0641

Authorized Official
Title or Position	:	CLINICAL MANAGER
Name	:	JESSICA KATHLEEN CAMARILLO
Credential	:	BCABA
Telephone Number	:	440-320-6543

Provider Enumeration Date	:	09/06/2020
Last Update Date	:	07/20/2022

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