Basic Information
Provider Information | |||||||||
NPI: | 1083824205 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BEHAVIOR ANALYSIS, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8001 SW 36TH ST | ||||||||
Address2: | SUITE 9 | ||||||||
City: | DAVIE | ||||||||
State: | FL | ||||||||
PostalCode: | 333281915 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9545777790 | ||||||||
FaxNumber: | 9545777780 | ||||||||
Practice Location | |||||||||
Address1: | 8001 SW 36TH ST | ||||||||
Address2: | SUITE 9 | ||||||||
City: | DAVIE | ||||||||
State: | FL | ||||||||
PostalCode: | 333281915 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9545777790 | ||||||||
FaxNumber: | 9545777780 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/23/2007 | ||||||||
LastUpdateDate: | 09/15/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MARUSSICH | ||||||||
AuthorizedOfficialFirstName: | SILVIA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
AuthorizedOfficialTelephone: | 9545777790 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MSW | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TB0200X | NA |   | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
ID Information
ID | Type | State | Issuer | Description | 671789698 | 05 | FL |   | MEDICAID | 671789696 | 05 | FL |   | MEDICAID |