Provider Demographics
NPI:1245688399
Name:KENDALL BEHAVIOR THERAPY
Entity type:Organization
Organization Name:KENDALL BEHAVIOR THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:P
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BCABA
Authorized Official - Phone:786-701-8164
Mailing Address - Street 1:12150 SW 128TH CT
Mailing Address - Street 2:SUITE 222
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4647
Mailing Address - Country:US
Mailing Address - Phone:786-701-8164
Mailing Address - Fax:786-701-3975
Practice Address - Street 1:12150 SW 128TH CT
Practice Address - Street 2:SUITE 222
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4647
Practice Address - Country:US
Practice Address - Phone:786-701-8164
Practice Address - Fax:786-701-3975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT 1614407103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty