Provider Demographics
NPI:1982214078
Name:IVY BEHAVIORAL INSTITUTE
Entity Type:Organization
Organization Name:IVY BEHAVIORAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAHEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDOOL-GHANY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D
Authorized Official - Phone:754-300-8185
Mailing Address - Street 1:5066 SW 137TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5902
Mailing Address - Country:US
Mailing Address - Phone:954-295-1167
Mailing Address - Fax:
Practice Address - Street 1:5066 SW 137TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5902
Practice Address - Country:US
Practice Address - Phone:954-295-1167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty