1922152768 NPI number — BEHAVIOR WORKS CORPORATION

Table of content: (NPI 1922152768)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922152768 NPI number — BEHAVIOR WORKS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIOR WORKS CORPORATION
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 WORKS
Provider Other Organization Name Type Code:
5
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:
1922152768
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37-2068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SATELLITE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32937-2068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-543-6729
Provider Business Mailing Address Fax Number:
321-631-3400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
759 WHITE PINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKLEDGE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32955-8143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-543-6729
Provider Business Practice Location Address Fax Number:
321-631-3400
Provider Enumeration Date:
01/22/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CUOMO
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
BRATER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-543-6729

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH-7903 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TS0200X , with the licence number: SS-664 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: SW-7500 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 346537 . This is a "HARMONY BEHAVIORAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".