MEDICARE: JODIE LOVE BCBA LLC

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

General Provider Information

NPI Number	:	1629735428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JODIE LOVE BCBA LLC

Provider Business Mailing Address
First Line	:	4674 SANTA CRUZ WAY
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-4484
Country	:	US
Telephone Number	:	786-865-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	4674 SANTA CRUZ WAY
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-4484
Country	:	US
Telephone Number	:	786-865-8166
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JODIE LOVE
Credential	:	MSD
Telephone Number	:	786-865-8166

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	11/29/2021

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Directions to “JODIE LOVE BCBA LLC ” Practice Location

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