MEDICARE: QUALITY BEHAVIOR THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	106S00000X	Behavior Technician
3	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	:	1942814991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY BEHAVIOR THERAPY LLC

Provider Business Mailing Address
First Line	:	3104 ORANOLE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-2017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 ORANOLE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32810-2017
Country	:	US
Telephone Number	:	407-501-0494
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	YANEYSI GARCIA
Credential	:
Telephone Number	:	407-501-0494

Provider Enumeration Date	:	09/06/2020
Last Update Date	:	09/07/2020

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Directions to “QUALITY BEHAVIOR THERAPY LLC ” Practice Location

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