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1060 W Sr 434 Ste 108 Longwood FL 32750-4953 | |
| (407) 324-7772 | |
| (321) 248-0717 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1060 W Sr 434 Ste 108, Longwood, Florida |
| Authorized Official Name and Position | Hyndi Eden Khomutetsky (OWNER) |
| Authorized Official Contact | 4073247772 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1060 W Sr 434 Ste 108 Longwood FL 32750-4953 Ph: (407) 324-7772 | 1060 W Sr 434 Ste 108 Longwood FL 32750-4953 Ph: (407) 324-7772 |
| NPI Number | 1891950671 |
|---|---|
| Provider Enumeration Date | 07/22/2008 |
| Last Update Date | 08/29/2023 |
| Certification Date | 08/29/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891950671 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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