Basic Information
| Provider Information | |||||||||
| NPI: | 1265991145 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIOR MATTERS SOUTHEAST LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13007 WOODFORD ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328326940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536866958 | ||||||||
| FaxNumber: | 8557265366 | ||||||||
| Practice Location | |||||||||
| Address1: | 13007 WOODFORD ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328326940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536866958 | ||||||||
| FaxNumber: | 8557265366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2019 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | EDGE | ||||||||
| AuthorizedOfficialFirstName: | REBEKA | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2536866958 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BCBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1-10-7144 | 01 | APPLIED BEHAVIOR ANALYSIS | OTHER |