Basic Information
| Provider Information | |||||||||
| NPI: | 1255080412 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIOR ANALYSIS AND THERAPY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8001 SW 36TH ST STE 9 | ||||||||
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| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333281915 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4150 FORD ST | ||||||||
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| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339169498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545777790 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2022 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | CASANOVA | ||||||||
| AuthorizedOfficialFirstName: | CLAUDIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 9545777790 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP |
No ID Information.