Provider Demographics
NPI:1972903524
Name:1ST JPA BEHAVIOR MANAGEMENT CLINIC INC
Entity type:Organization
Organization Name:1ST JPA BEHAVIOR MANAGEMENT CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMARILYS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-200-7425
Mailing Address - Street 1:19001 SW 106TH AVE
Mailing Address - Street 2:SUITE C103
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-7669
Mailing Address - Country:US
Mailing Address - Phone:786-523-2352
Mailing Address - Fax:786-431-4078
Practice Address - Street 1:19001 SW 106TH AVE
Practice Address - Street 2:SUITE C103
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-7669
Practice Address - Country:US
Practice Address - Phone:786-523-2352
Practice Address - Fax:786-431-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X, 103K00000X, 106H00000X, 251B00000X, 251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014923500Medicaid
FL014923501Medicaid
FL018511200Medicaid