Basic Information
| Provider Information | |||||||||
| NPI: | 1760120596 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SMART BEHAVIORAL INNOVATION CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 SW FEDERAL HWY STE C2A | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349942925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052998005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 611 SW FEDERAL HWY STE C2A | ||||||||
| Address2: | |||||||||
| City: | STUART | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349942925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052998005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2022 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | RAMOS | ||||||||
| AuthorizedOfficialFirstName: | ALFREDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3052998005 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMHC | ||||||||
| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.