Provider Demographics
NPI:1114285194
Name:HEALTH AND BEHAVIORAL DIMENSIONS
Entity Type:Organization
Organization Name:HEALTH AND BEHAVIORAL DIMENSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, BCBA
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GREENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, BCBA
Authorized Official - Phone:954-260-3234
Mailing Address - Street 1:2269 S UNIVERSITY DR STE 338
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-5856
Mailing Address - Country:US
Mailing Address - Phone:954-260-3234
Mailing Address - Fax:
Practice Address - Street 1:2269 S UNIVERSITY DR STE 338
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-5856
Practice Address - Country:US
Practice Address - Phone:954-260-3234
Practice Address - Fax:954-437-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty