Provider Demographics
NPI:1598463267
Name:IC BEHAVIOR SERVICES INC
Entity type:Organization
Organization Name:IC BEHAVIOR SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:
Authorized Official - First Name:ILIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMEJO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/APRN
Authorized Official - Phone:305-978-2972
Mailing Address - Street 1:15315 NW 60TH AVE STE D
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2440
Mailing Address - Country:US
Mailing Address - Phone:305-978-2972
Mailing Address - Fax:
Practice Address - Street 1:15315 NW 60TH AVE STE D
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2440
Practice Address - Country:US
Practice Address - Phone:305-978-2972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty