MEDICARE: INNERCONNECTIONS DEVELOPMENTAL SPECIALISTS INC.

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

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	:	1891249678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNERCONNECTIONS DEVELOPMENTAL SPECIALISTS INC.

Provider Business Mailing Address
First Line	:	240 NW 25TH ST APT 417
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33127-4347
Country	:	US
Telephone Number	:	786-457-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 GIRALDA AVE STE 6-113
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-5002
Country	:	US
Telephone Number	:	786-310-2352
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, CLINICAL DIRECTOR
Name	:	MS. CHRISTIAN MENDEZ
Credential	:	MS, BCBA
Telephone Number	:	786-310-2352

Provider Enumeration Date	:	08/09/2016
Last Update Date	:	05/13/2021

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