MEDICARE: CHILDREN'S PARADISE BEHAVIORAL THERAPY INC.

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	106E00000X	Assistant Behavior Analyst
3	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1669996021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S PARADISE BEHAVIORAL THERAPY INC.

Provider Business Mailing Address
First Line	:	16233 NW 86TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-8507
Country	:	US
Telephone Number	:	305-726-8502
Fax Number	:	305-827-8978

Provider Business Practice Location Address
First Line	:	15520 NW 77TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-5804
Country	:	US
Telephone Number	:	305-726-8502
Fax Number	:	305-827-8978

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	JONAIKY MIRANDA
Credential	:
Telephone Number	:	305-726-8502

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	07/27/2017

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