MEDICARE: MR. KENNETH JAMES BEITER

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		FL

General Provider Information

NPI Number	:	1952154379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH JAMES BEITER

Provider Business Mailing Address
First Line	:	1500 S DOUGLAS RD STE 230
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4108
Country	:	US
Telephone Number	:	844-406-3878
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 GUNN HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-6379
Country	:	US
Telephone Number	:	813-733-8572
Fax Number	:

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

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	06/08/2026

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Directions to “ MR. KENNETH JAMES BEITER ” Practice Location

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