Provider Demographics
NPI:1447090204
Name:FADING BEHAVIOR SERVICES LLC
Entity type:Organization
Organization Name:FADING BEHAVIOR SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:
Authorized Official - First Name:YANELYS
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTO GALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-351-4493
Mailing Address - Street 1:2120 NW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-2556
Mailing Address - Country:US
Mailing Address - Phone:786-351-4493
Mailing Address - Fax:
Practice Address - Street 1:2120 NW 98TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-2556
Practice Address - Country:US
Practice Address - Phone:786-351-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty