Basic Information
| Provider Information | |||||||||
| NPI: | 1154053031 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE PIECES FIT INTERVENTIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13538 VILLAGE PARK DR STE 145 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328373600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077302948 | ||||||||
| FaxNumber: | 4072504833 | ||||||||
| Practice Location | |||||||||
| Address1: | 13355 W COLONIAL DR | ||||||||
| Address2: | |||||||||
| City: | WINTER GARDEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347873970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077302948 | ||||||||
| FaxNumber: | 4072504833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2022 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | SANTIAGO | ||||||||
| AuthorizedOfficialFirstName: | CARLOS | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4077302948 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THE PIECES FIT INTERVENTIONS LLC | ||||||||
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| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.