Provider Demographics
NPI:1114501822
Name:CHILD DEVELOPMENT SPECIALISTS, LLC
Entity Type:Organization
Organization Name:CHILD DEVELOPMENT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR/ITDS
Authorized Official - Prefix:
Authorized Official - First Name:LIVIA
Authorized Official - Middle Name:COSTA DE MATTOS
Authorized Official - Last Name:DE PAULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-260-1699
Mailing Address - Street 1:22309 COLLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4743
Mailing Address - Country:US
Mailing Address - Phone:954-260-1699
Mailing Address - Fax:
Practice Address - Street 1:22309 COLLINGTON DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4743
Practice Address - Country:US
Practice Address - Phone:954-260-1699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-09
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811620200Medicaid