Provider Demographics
NPI:1477316370
Name:LTO BEHAVIOR SERVICES
Entity Type:Organization
Organization Name:LTO BEHAVIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYSELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO PENATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-554-1676
Mailing Address - Street 1:14000 SW 153RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4652
Mailing Address - Country:US
Mailing Address - Phone:786-554-1676
Mailing Address - Fax:
Practice Address - Street 1:26039 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-6613
Practice Address - Country:US
Practice Address - Phone:786-554-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LTO BEHAVIOR SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty