Provider Demographics
NPI:1063911055
Name:DEVELOPMENT BEHAVIOR THERAPY CORP
Entity type:Organization
Organization Name:DEVELOPMENT BEHAVIOR THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BORRAJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-603-9204
Mailing Address - Street 1:10300 SW 72 ND ST STE 350
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3019
Mailing Address - Country:US
Mailing Address - Phone:305-603-9204
Mailing Address - Fax:305-603-9206
Practice Address - Street 1:10300 SW 72 ND ST STE 350
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3019
Practice Address - Country:US
Practice Address - Phone:305-603-9204
Practice Address - Fax:305-603-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid