Provider Demographics
NPI:1508520511
Name:DAA BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:DAA BEHAVIORAL HEALTH LLC
Other - Org Name:DAA BEHAVIORAL HEALTH LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA CUDEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA 1-21-51502
Authorized Official - Phone:786-805-8076
Mailing Address - Street 1:6721 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1807
Mailing Address - Country:US
Mailing Address - Phone:786-805-8076
Mailing Address - Fax:786-386-0934
Practice Address - Street 1:6721 ALLEN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-1807
Practice Address - Country:US
Practice Address - Phone:786-805-8076
Practice Address - Fax:786-386-0934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103919500Medicaid