MEDICARE: FRACTALS BEHAVIORAL SERVICES 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	:	1861373946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRACTALS BEHAVIORAL SERVICES LLC

Provider Business Mailing Address
First Line	:	1600 N 68TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-5724
Country	:	US
Telephone Number	:	786-620-4619
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N 68TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-5724
Country	:	US
Telephone Number	:	786-620-4619
Fax Number	:

Authorized Official
Title or Position	:	AMBR
Name	:	BELKIS PEREZ
Credential	:
Telephone Number	:	786-620-4619

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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