Provider Demographics
NPI:1033837844
Name:KIWI BEHAVIORAL THERAPY, LLC
Entity Type:Organization
Organization Name:KIWI BEHAVIORAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, RBT
Authorized Official - Phone:954-662-9796
Mailing Address - Street 1:107 NE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4218
Mailing Address - Country:US
Mailing Address - Phone:954-256-0357
Mailing Address - Fax:
Practice Address - Street 1:107 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4218
Practice Address - Country:US
Practice Address - Phone:954-256-0357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty