Provider Demographics
NPI:1386220432
Name:SOUTHWEST FLORIDA BEHAVIORAL HEALTH L.L.C.
Entity Type:Organization
Organization Name:SOUTHWEST FLORIDA BEHAVIORAL HEALTH L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:CHICA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:239-738-6365
Mailing Address - Street 1:124 SW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-4555
Mailing Address - Country:US
Mailing Address - Phone:239-738-6365
Mailing Address - Fax:
Practice Address - Street 1:124 SW 31ST ST
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-4555
Practice Address - Country:US
Practice Address - Phone:239-738-6365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty