Provider Demographics
NPI:1982241295
Name:FLORIDA BEHAVIOR ASSOCIATES LLC
Entity Type:Organization
Organization Name:FLORIDA BEHAVIOR ASSOCIATES LLC
Other - Org Name:FLORIDA BEHAVIOR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-520-5200
Mailing Address - Street 1:712 S OCEAN SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-3602
Mailing Address - Country:US
Mailing Address - Phone:386-227-6485
Mailing Address - Fax:866-247-1790
Practice Address - Street 1:712 S OCEAN SHORE BLVD
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-3602
Practice Address - Country:US
Practice Address - Phone:386-227-6485
Practice Address - Fax:866-247-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-05
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty