Provider Demographics
NPI:1962900167
Name:MINDGARDEN THERAPY CENTER CORP
Entity type:Organization
Organization Name:MINDGARDEN THERAPY CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENCOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-717-8011
Mailing Address - Street 1:801 W 50TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3413
Mailing Address - Country:US
Mailing Address - Phone:786-717-8011
Mailing Address - Fax:
Practice Address - Street 1:15250 DURNFORD DR
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2328
Practice Address - Country:US
Practice Address - Phone:786-717-8011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty