Provider Demographics
NPI:1689371890
Name:PEDIATRIC THERAPY SUPPORT LLC
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MS
Authorized Official - First Name:YUNEISI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-253-5248
Mailing Address - Street 1:93911 OVERSEAS HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-3025
Mailing Address - Country:US
Mailing Address - Phone:786-253-5248
Mailing Address - Fax:
Practice Address - Street 1:93911 OVERSEAS HWY STE 4
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-3025
Practice Address - Country:US
Practice Address - Phone:786-253-5248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1760902167Medicaid