Provider Demographics
NPI:1821704644
Name:DIVERSE FAMILY SOLUTION ABA THERAPY
Entity Type:Organization
Organization Name:DIVERSE FAMILY SOLUTION ABA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-993-0706
Mailing Address - Street 1:2228 NE 16TH CT
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-5118
Mailing Address - Country:US
Mailing Address - Phone:954-993-0706
Mailing Address - Fax:
Practice Address - Street 1:2228 NE 16TH CT
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-5118
Practice Address - Country:US
Practice Address - Phone:954-993-0706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health