MEDICARE: BEHAVIOR MANAGEMENT CENTER INC

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

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	:	1588320253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIOR MANAGEMENT CENTER INC

Provider Business Mailing Address
First Line	:	4226 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7168
Country	:	US
Telephone Number	:	786-606-4348
Fax Number	:

Provider Business Practice Location Address
First Line	:	4226 DEL PRADO BLVD S
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-7168
Country	:	US
Telephone Number	:	786-606-4348
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	MRS. YACSA FLEITES VALDES
Credential	:
Telephone Number	:	786-606-4348

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	02/20/2025

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