MEDICARE: FULL SPECTRUM INTEGRATED EDUCATIONAL SUPPORT SERVICES, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1992233449
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULL SPECTRUM INTEGRATED EDUCATIONAL SUPPORT SERVICES, LLC

Provider Business Mailing Address
First Line	:	801 BRICKELL KEY BLVD APT 2007
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3718
Country	:	US
Telephone Number	:	561-302-9353
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 BRICKELL KEY BLVD APT 2007
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3718
Country	:	US
Telephone Number	:	561-302-9353
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHLOE CAVAYERO
Credential	:	BCBA
Telephone Number	:	561-302-9353

Provider Enumeration Date	:	05/29/2017
Last Update Date	:	07/21/2022

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