Provider Demographics
NPI:1891164281
Name:M&D BEHAVIOR SERVICE CORP
Entity Type:Organization
Organization Name:M&D BEHAVIOR SERVICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARQUETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-310-7064
Mailing Address - Street 1:2750 SW 87TH AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3264
Mailing Address - Country:US
Mailing Address - Phone:786-536-5289
Mailing Address - Fax:
Practice Address - Street 1:2750 SW 87TH AVE STE 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3264
Practice Address - Country:US
Practice Address - Phone:786-536-5289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child