MEDICARE: CRECER BEHAVIOR SUPPORT , 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	:	1881401958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRECER BEHAVIOR SUPPORT , LLC

Provider Business Mailing Address
First Line	:	4307 W BIRD ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-2507
Country	:	US
Telephone Number	:	813-454-1463
Fax Number	:

Provider Business Practice Location Address
First Line	:	6750 N ANDREWS AVE STE 2043
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2173
Country	:	US
Telephone Number	:	813-784-3619
Fax Number	:	813-305-7033

Authorized Official
Title or Position	:	OWNER
Name	:	ILEANA DE CABO HERNANDEZ
Credential	:
Telephone Number	:	813-454-1463

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	12/12/2024

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