Provider Demographics
NPI:1609518257
Name:ADVANCE BEHAVIOR INSTITUTE INC
Entity Type:Organization
Organization Name:ADVANCE BEHAVIOR INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:MACEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-357-7808
Mailing Address - Street 1:3820 COLONIAL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1094
Mailing Address - Country:US
Mailing Address - Phone:786-357-7808
Mailing Address - Fax:
Practice Address - Street 1:3820 COLONIAL BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1094
Practice Address - Country:US
Practice Address - Phone:786-357-7808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty