Provider Demographics
NPI:1447757414
Name:ELITE BEHAVIOR SPECIALIST
Entity Type:Organization
Organization Name:ELITE BEHAVIOR SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHABELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-427-5745
Mailing Address - Street 1:8942 NW 112TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4578
Mailing Address - Country:US
Mailing Address - Phone:786-427-5745
Mailing Address - Fax:
Practice Address - Street 1:8942 NW 112TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4578
Practice Address - Country:US
Practice Address - Phone:786-427-5745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty