Provider Demographics
NPI:1497347272
Name:CHILD BEHAVIOR CENTER, INC.
Entity Type:Organization
Organization Name:CHILD BEHAVIOR CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:321-303-4819
Mailing Address - Street 1:3051 MENORCA CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4124
Mailing Address - Country:US
Mailing Address - Phone:321-303-4819
Mailing Address - Fax:866-532-6911
Practice Address - Street 1:897 TOWNE CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3473
Practice Address - Country:US
Practice Address - Phone:321-303-4819
Practice Address - Fax:866-532-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty