Provider Demographics
NPI:1235915059
Name:EARLY BEHAVIOR THERAPY LLC
Entity Type:Organization
Organization Name:EARLY BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-901-0122
Mailing Address - Street 1:9380 SW 72ND ST STE B-252
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3276
Mailing Address - Country:US
Mailing Address - Phone:786-238-7734
Mailing Address - Fax:786-238-7735
Practice Address - Street 1:9380 SW 72ND ST STE B-252
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3276
Practice Address - Country:US
Practice Address - Phone:786-238-7734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health