Provider Demographics
NPI:1386790186
Name:DE PAULA, LIVIA COSTA DE MATTOS (MED,)
Entity type:Individual
Prefix:
First Name:LIVIA
Middle Name:COSTA DE MATTOS
Last Name:DE PAULA
Suffix:
Gender:F
Credentials:MED,
Other - Prefix:
Other - First Name:DBA CHILD
Other - Middle Name:
Other - Last Name:DEVELOPMENT SPECIALISTS, LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22309 COLLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4743
Mailing Address - Country:US
Mailing Address - Phone:954-260-1699
Mailing Address - Fax:
Practice Address - Street 1:22309 COLLINGTON DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4743
Practice Address - Country:US
Practice Address - Phone:954-260-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL811620200Medicaid