Provider Demographics
NPI:1225810674
Name:MBC BEHAVIOR ANALYSIS LLC
Entity Type:Organization
Organization Name:MBC BEHAVIOR ANALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALART CID
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-553-3846
Mailing Address - Street 1:9299 SW 152ND ST STE 200D
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1776
Mailing Address - Country:US
Mailing Address - Phone:786-302-3814
Mailing Address - Fax:
Practice Address - Street 1:9299 SW 152ND ST STE 200D
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1776
Practice Address - Country:US
Practice Address - Phone:786-302-3814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty