| NPI | 1104332394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA BENCID Sole Member 786-301-7622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-17-27747) |
| 261QD1600X Clinic/Center, Developmental Disabilities | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2017-12-27 |