Provider Demographics
NPI:1942958715
Name:APPLIED BEHAVIORAL SUPPORT
Entity Type:Organization
Organization Name:APPLIED BEHAVIORAL SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XIORELI
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-600-1709
Mailing Address - Street 1:660 FALLING WATER RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3551
Mailing Address - Country:US
Mailing Address - Phone:954-600-1709
Mailing Address - Fax:954-206-0789
Practice Address - Street 1:660 FALLING WATER RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3551
Practice Address - Country:US
Practice Address - Phone:954-600-1709
Practice Address - Fax:954-206-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-11
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty