Provider Demographics
NPI:1013211184
Name:PSYCHOLOGY AND BEHAVIOR SERVICES
Entity Type:Organization
Organization Name:PSYCHOLOGY AND BEHAVIOR SERVICES
Other - Org Name:FRANK D ROSA, CBA
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA-D
Authorized Official - Phone:305-801-8957
Mailing Address - Street 1:11233 NW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3543
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4882 NW 4TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2171
Practice Address - Country:US
Practice Address - Phone:305-639-3049
Practice Address - Fax:305-639-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL673561496OtherMEDICAID WAIVER - HOME AND COMMUNITY BASED SERVICES WAIVER
FL673561498OtherMEDICAID WAIVER - FAMILY AND SUPPORTED LIVING WAIVER