Provider Demographics
NPI:1679190078
Name:BEHAVIORAL MULTIDISCIPLINARY CENTER CORP
Entity Type:Organization
Organization Name:BEHAVIORAL MULTIDISCIPLINARY CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIELY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, MBA
Authorized Official - Phone:407-541-7965
Mailing Address - Street 1:13536 TURTLE MARSH LOOP APT 537
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6622
Mailing Address - Country:US
Mailing Address - Phone:407-541-7965
Mailing Address - Fax:
Practice Address - Street 1:13536 TURTLE MARSH LOOP APT 537
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6622
Practice Address - Country:US
Practice Address - Phone:407-541-7965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty