Provider Demographics
NPI: | 1073187357 |
---|---|
Name: | BEHAVIORAL PARTNERS LLC |
Entity Type: | Organization |
Organization Name: | BEHAVIORAL PARTNERS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANTONIO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | QUINTANA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 786-803-9360 |
Mailing Address - Street 1: | 2213 NW 2ND AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | CAPE CORAL |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33993-4139 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 239-710-1815 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2620 PIERCE ST |
Practice Address - Street 2: | |
Practice Address - City: | HOLLYWOOD |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33020-3827 |
Practice Address - Country: | US |
Practice Address - Phone: | 786-803-9360 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-05-19 |
Last Update Date: | 2023-11-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | Q535010904450 | Other | DL |