Provider Demographics
NPI:1790426013
Name:BEEHAVIOR THERAPY FOR AUTISM
Entity Type:Organization
Organization Name:BEEHAVIOR THERAPY FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NIURKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:954-662-3978
Mailing Address - Street 1:4449 NW 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5256
Mailing Address - Country:US
Mailing Address - Phone:954-662-3978
Mailing Address - Fax:
Practice Address - Street 1:4449 NW 92ND AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-5256
Practice Address - Country:US
Practice Address - Phone:954-662-3978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty