Provider Demographics
NPI:1487915948
Name:APPLIED BEHAVIOR SOLUTIONS, LLC
Entity type:Organization
Organization Name:APPLIED BEHAVIOR SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, BCBA, LCSW
Authorized Official - Phone:305-822-7202
Mailing Address - Street 1:2100 W 76TH ST
Mailing Address - Street 2:SUITE #405
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5539
Mailing Address - Country:US
Mailing Address - Phone:305-822-7202
Mailing Address - Fax:305-822-7203
Practice Address - Street 1:2100 W 76TH ST
Practice Address - Street 2:SUITE #405
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5539
Practice Address - Country:US
Practice Address - Phone:305-822-7202
Practice Address - Fax:305-822-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6104101YP2500X, 1041C0700X
FL1-03-1183103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685428196OtherMEDICAID HOME COMMUNITY BASED WAIVER