MEDICARE: LITTLE SMILE BEHAVIORAL CORP

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	:	1922888411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE SMILE BEHAVIORAL CORP

Provider Business Mailing Address
First Line	:	12150 SW 128TH CT STE 125
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4672
Country	:	US
Telephone Number	:	786-878-8525
Fax Number	:

Provider Business Practice Location Address
First Line	:	12150 SW 128TH CT STE 125
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4672
Country	:	US
Telephone Number	:	786-878-8525
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LIANETT BORGES CABRERA
Credential	:
Telephone Number	:	786-878-8525

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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Directions to “LITTLE SMILE BEHAVIORAL CORP ” Practice Location

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