Provider Demographics
NPI:1336434836
Name:BREVARD BEHAVIORAL CONSULTANTS, INC
Entity Type:Organization
Organization Name:BREVARD BEHAVIORAL CONSULTANTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-544-7684
Mailing Address - Street 1:1900 S HARBOR CITY BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4901
Mailing Address - Country:US
Mailing Address - Phone:321-432-9738
Mailing Address - Fax:321-296-7144
Practice Address - Street 1:1900 S HARBOR CITY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4901
Practice Address - Country:US
Practice Address - Phone:321-432-9738
Practice Address - Fax:321-296-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health