Provider Demographics
NPI:1326588781
Name:MY BA THERAPY CENTER INC.
Entity Type:Organization
Organization Name:MY BA THERAPY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE NOBREGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-910-3247
Mailing Address - Street 1:8378 LUDINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5910
Mailing Address - Country:US
Mailing Address - Phone:407-352-5279
Mailing Address - Fax:
Practice Address - Street 1:7380 W SAND LAKE RD STE 541
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5248
Practice Address - Country:US
Practice Address - Phone:407-385-0728
Practice Address - Fax:407-386-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty