Provider Demographics
NPI:1043946544
Name:KIDDO'S BEHAVIOR THERAPY LLC
Entity type:Organization
Organization Name:KIDDO'S BEHAVIOR THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-309-2119
Mailing Address - Street 1:12001 SW 128TH CT STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4666
Mailing Address - Country:US
Mailing Address - Phone:786-309-2119
Mailing Address - Fax:786-305-7613
Practice Address - Street 1:12001 SW 128TH CT STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4666
Practice Address - Country:US
Practice Address - Phone:786-309-2119
Practice Address - Fax:786-305-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty