Provider Demographics
NPI:1932860517
Name:SUNRISE BEHAVIORAL THERAPY,LLC
Entity Type:Organization
Organization Name:SUNRISE BEHAVIORAL THERAPY,LLC
Other - Org Name:SUNRISE BEHAVIORAL THERAPY,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:B, A
Authorized Official - Phone:305-562-1983
Mailing Address - Street 1:2000 NW 89TH PL
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2618
Mailing Address - Country:US
Mailing Address - Phone:305-562-1983
Mailing Address - Fax:305-230-2535
Practice Address - Street 1:2000 NW 89TH PL
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2618
Practice Address - Country:US
Practice Address - Phone:305-562-1983
Practice Address - Fax:305-230-2535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty