Provider Demographics
NPI:1568170389
Name:WITTY CHILDREN BEHAVIOR THERAPY
Entity Type:Organization
Organization Name:WITTY CHILDREN BEHAVIOR THERAPY
Other - Org Name:WITTY CHILDREN BEHAVIOR THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:954-384-4008
Mailing Address - Street 1:3350 SW 148TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3244
Mailing Address - Country:US
Mailing Address - Phone:954-384-4008
Mailing Address - Fax:
Practice Address - Street 1:5801 NW 151ST ST STE 200A
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2474
Practice Address - Country:US
Practice Address - Phone:786-879-2117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022019200Medicaid