Provider Demographics
NPI:1972994812
Name:BEHAVIORAL SUPPORT SERVICES
Entity type:Organization
Organization Name:BEHAVIORAL SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH TARGETED CASE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANIBAL
Authorized Official - Last Name:BARRETO
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:407-965-8013
Mailing Address - Street 1:2495 HURON CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-3443
Mailing Address - Country:US
Mailing Address - Phone:407-965-8013
Mailing Address - Fax:
Practice Address - Street 1:2495 HURON CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-3443
Practice Address - Country:US
Practice Address - Phone:407-965-8013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health