Provider Demographics
NPI:1659002434
Name:BEHAVIOR PLAN
Entity Type:Organization
Organization Name:BEHAVIOR PLAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACKELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-487-6449
Mailing Address - Street 1:2054 VISTA PARKWAY
Mailing Address - Street 2:EMERALD VIEW SUITE 400 OFFICE 420
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411
Mailing Address - Country:US
Mailing Address - Phone:786-487-6449
Mailing Address - Fax:
Practice Address - Street 1:2054 VISTA PARKWAY
Practice Address - Street 2:EMERALD VIEW SUITE 400 OFFICE 420
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411
Practice Address - Country:US
Practice Address - Phone:786-487-6449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty