Provider Demographics
NPI:1992233449
Name:FULL SPECTRUM INTEGRATED EDUCATIONAL SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:FULL SPECTRUM INTEGRATED EDUCATIONAL SUPPORT SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVAYERO
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:561-302-9353
Mailing Address - Street 1:801 BRICKELL KEY BLVD APT 2007
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3718
Mailing Address - Country:US
Mailing Address - Phone:561-302-9353
Mailing Address - Fax:
Practice Address - Street 1:801 BRICKELL KEY BLVD APT 2007
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3718
Practice Address - Country:US
Practice Address - Phone:561-302-9353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health