Provider Demographics
NPI:1770108144
Name:CAMPOS AND CAMPOS BEHAVIOR THERAPY LLC
Entity type:Organization
Organization Name:CAMPOS AND CAMPOS BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-612-7186
Mailing Address - Street 1:3921 BATTERSEA RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6705
Mailing Address - Country:US
Mailing Address - Phone:786-612-7186
Mailing Address - Fax:
Practice Address - Street 1:3921 BATTERSEA RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-6705
Practice Address - Country:US
Practice Address - Phone:786-612-7186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023625300Medicaid