Basic Information
| Provider Information | |||||||||
| NPI: | 1902497365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMA BEHAVIORAL SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 W PALMETTO PARK RD STE 300C | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334323761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862785903 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 W PALMETTO PARK RD STE 300C | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334323761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7865083245 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2021 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| AuthorizedOfficialLastName: | DELGADO | ||||||||
| AuthorizedOfficialFirstName: | YAILET | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7862785903 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
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 | 832158 | 05 | FL | MEDICAID |