MEDICARE: CIERRO KENNEDY

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	1-25-86611	FL
2	106S00000X	Behavior Technician

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	:	1588208649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIERRO KENNEDY

Provider Business Mailing Address
First Line	:	6927 W SUNRISE BLVD APT 201
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33313-4495
Country	:	US
Telephone Number	:	706-590-5304
Fax Number	:

Provider Business Practice Location Address
First Line	:	6416 NW 5TH WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-6112
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	01/12/2026

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Directions to “ CIERRO KENNEDY ” Practice Location

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