Provider Demographics
NPI:1528672961
Name:BEHA.VIO
Entity type:Organization
Organization Name:BEHA.VIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:GILLIE
Authorized Official - Middle Name:JOHANNA
Authorized Official - Last Name:ACOSTA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:407-952-8880
Mailing Address - Street 1:267 LAKE DAVENPORT CIR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-7527
Mailing Address - Country:US
Mailing Address - Phone:407-952-8880
Mailing Address - Fax:
Practice Address - Street 1:267 LAKE DAVENPORT CIR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7527
Practice Address - Country:US
Practice Address - Phone:407-952-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty