MEDICARE: DIANE MARIE BRAHIM

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1982129086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE MARIE BRAHIM

Provider Business Mailing Address
First Line	:	16400 NW 13TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-1308
Country	:	US
Telephone Number	:	954-829-2281
Fax Number	:

Provider Business Practice Location Address
First Line	:	3891 STIRLING RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6216
Country	:	US
Telephone Number	:	954-416-2444
Fax Number	:

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

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	08/09/2017

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