Provider Demographics
NPI:1881401958
Name:CRECER BEHAVIOR SUPPORT , LLC
Entity type:Organization
Organization Name:CRECER BEHAVIOR SUPPORT , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ILEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE CABO HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-454-1463
Mailing Address - Street 1:4307 W BIRD ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2507
Mailing Address - Country:US
Mailing Address - Phone:813-454-1463
Mailing Address - Fax:
Practice Address - Street 1:6750 N ANDREWS AVE STE 2043
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2173
Practice Address - Country:US
Practice Address - Phone:813-784-3619
Practice Address - Fax:813-305-7033
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRECER BEHAVIOR SUPPORT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty