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NPI Code Detail

MEDICARE: SECRET CARREON

MEDICARE: SECRET CARREON
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
1222Q00000XDevelopmental Therapist
2103K00000XBehavior AnalystTX

General Provider Information

NPI Number : 1841693041
Entity Type Code : Individual
Provider Name (Legal Business Name) : SECRET CARREON
Provider Business Mailing Address
First Line : 500 FAIRWAY DR
Second Line : STE. 102
City : DEERFIELD BEACH
State : FL
Zip : 33441-1814
Country : US
Telephone Number : 888-880-9270
Fax Number :
Provider Business Practice Location Address
First Line : 1635 S FRY RD
Second Line :
City : KATY
State : TX
Zip : 77450-6404
Country : US
Telephone Number : 281-616-8075
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2014
Last Update Date : 10/23/2019

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Directions to “ SECRET CARREON ” Practice Location

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