1326682410 NPI number — BEHAVIOR INTEGRATIONS, LLC

Table of content: (NPI 1326682410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326682410 NPI number — BEHAVIOR INTEGRATIONS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIOR INTEGRATIONS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEHAVIOR INTEGRATIONS, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326682410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3641 HADDINGTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APOPKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32712-5690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-937-9016
Provider Business Mailing Address Fax Number:
407-703-9561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
498 N STATE ROAD 434 STE 1011
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714-2172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-810-5315
Provider Business Practice Location Address Fax Number:
407-703-9561
Provider Enumeration Date:
10/31/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRACERO
Authorized Official First Name:
VANESSA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
407-937-9016

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1730417239 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018800600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 104708800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".