Provider Demographics
NPI:1073992806
Name:BEHAVIORAL SUPPORT NETWORK
Entity Type:Organization
Organization Name:BEHAVIORAL SUPPORT NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ITDS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELEON-ARINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-442-4495
Mailing Address - Street 1:13429 FLADGATE MARK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2379
Mailing Address - Country:US
Mailing Address - Phone:813-442-4495
Mailing Address - Fax:813-442-4495
Practice Address - Street 1:13429 FLADGATE MARK DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2379
Practice Address - Country:US
Practice Address - Phone:813-442-4495
Practice Address - Fax:813-442-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency