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NPI Code Detail

MEDICARE: BEHAVIORAL STRIDES THERAPY

MEDICARE: BEHAVIORAL STRIDES 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
1103K00000XBehavior AnalystFL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11013209097OTHERFLNPI
21649532383OTHERFLNPI

General Provider Information

NPI Number : 1568911683
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEHAVIORAL STRIDES THERAPY
Provider Business Mailing Address
First Line : 5850 ATLANTIC AVE STE 112
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33484-8427
Country : US
Telephone Number : 561-336-0358
Fax Number :
Provider Business Practice Location Address
First Line : 5850 ATLANTIC AVE STE 112
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33484-8427
Country : US
Telephone Number : 561-336-0358
Fax Number :
Authorized Official
Title or Position : CO-PRESIDENT
Name : JULIE DIAGO
Credential : BCBA
Telephone Number : 561-336-0358
Provider Enumeration Date : 09/30/2016
Last Update Date : 08/31/2021

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1649532383 — LI-OR WHITE MASTERS IN EDUCATION
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Directions to “BEHAVIORAL STRIDES THERAPY ” Practice Location

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