Provider Demographics
NPI:1427313873
Name:BEHAVIORAL SUPPORT SERVICES INC
Entity type:Organization
Organization Name:BEHAVIORAL SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MP
Authorized Official - Phone:386-215-7830
Mailing Address - Street 1:1394 DUNLAWTON AVE APT 805
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4762
Mailing Address - Country:US
Mailing Address - Phone:386-215-7830
Mailing Address - Fax:407-830-8413
Practice Address - Street 1:315 N LAKEMONT AVE STE B
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3205
Practice Address - Country:US
Practice Address - Phone:386-215-7830
Practice Address - Fax:407-830-8413
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL SUPPORT SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL159646529Medicare Oscar/Certification