Provider Demographics
NPI:1700585858
Name:FIDELITY BEHAVIORAL ALLIANCE
Entity Type:Organization
Organization Name:FIDELITY BEHAVIORAL ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:DR
Authorized Official - First Name:DLAUREN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MONDESIR
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:561-463-0913
Mailing Address - Street 1:2500 QUANTUM LAKES DR STE 203
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8323
Mailing Address - Country:US
Mailing Address - Phone:561-463-0913
Mailing Address - Fax:
Practice Address - Street 1:2500 QUANTUM LAKES DR STE 203
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8323
Practice Address - Country:US
Practice Address - Phone:561-463-0913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty