Provider Demographics
NPI:1417660754
Name:MR BEHAVIORAL SERVICES LLC
Entity type:Organization
Organization Name:MR BEHAVIORAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILEIDYS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-342-7852
Mailing Address - Street 1:1380 NE MIAMI GARDENS DR STE 142
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:813-547-8889
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 142
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4744
Practice Address - Country:US
Practice Address - Phone:973-342-7852
Practice Address - Fax:813-547-8889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty