MEDICARE: ABC BEHAVIORAL SERVICES CORP

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	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
2	251S00000X	Community/Behavioral Health Agency

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	:	1700423316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABC BEHAVIORAL SERVICES CORP

Provider Business Mailing Address
First Line	:	7218 N LOIS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3161
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7218 N LOIS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3161
Country	:	US
Telephone Number	:	305-988-2969
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	LIANET MUNOZ
Credential	:
Telephone Number	:	305-988-2969

Provider Enumeration Date	:	12/02/2019
Last Update Date	:	08/06/2024

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Directions to “ABC BEHAVIORAL SERVICES CORP ” Practice Location

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