Provider Demographics
NPI:1265708192
Name:AVANTI BEHAVIORAL CHANGE
Entity type:Organization
Organization Name:AVANTI BEHAVIORAL CHANGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIRVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CPC, ITDS
Authorized Official - Phone:305-607-4116
Mailing Address - Street 1:9595 FONTAINEBLEAU BLVD
Mailing Address - Street 2:APT 2002
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6883
Mailing Address - Country:US
Mailing Address - Phone:305-607-4116
Mailing Address - Fax:305-503-7088
Practice Address - Street 1:9595 FONTAINEBLEAU BLVD
Practice Address - Street 2:APT 2002
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-6883
Practice Address - Country:US
Practice Address - Phone:305-607-4116
Practice Address - Fax:305-503-7088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency