Provider Demographics
NPI:1992133698
Name:DEVELOPMENTAL INTERVENTION SPECIALISTS
Entity type:Organization
Organization Name:DEVELOPMENTAL INTERVENTION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:800-686-5614
Mailing Address - Street 1:1779 N CONGRESS AVE # 336
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8205
Mailing Address - Country:US
Mailing Address - Phone:800-686-5614
Mailing Address - Fax:561-736-5800
Practice Address - Street 1:1779 N CONGRESS AVE # 336
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8205
Practice Address - Country:US
Practice Address - Phone:800-686-5614
Practice Address - Fax:561-736-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health