MEDICARE: MRS. MARIA PRESTON BEHAVIOR ANALYST

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	1-14-16773	FL

General Provider Information

NPI Number	:	1861815383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA PRESTON BEHAVIOR ANALYST

Provider Business Mailing Address
First Line	:	1925 LAKE POINT DR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-2356
Country	:	US
Telephone Number	:	954-401-2024
Fax Number	:	954-434-1741

Provider Business Practice Location Address
First Line	:	1925 LAKE POINT DR
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-2356
Country	:	US
Telephone Number	:	954-401-2024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2014
Last Update Date	:	04/20/2015

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