| Lasting Change Llc | |
|
1645 Palm Beach Lakes Blvd Ste 1200 West Palm Beach FL 33401-2214 | |
| (561) 788-3113 | |
| Not Available |
| Full Name | Lasting Change Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 1645 Palm Beach Lakes Blvd Ste 1200, West Palm Beach, Florida |
| Authorized Official Name and Position | Ednei Estevez (OWNER) |
| Authorized Official Contact | 5617883113 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lasting Change Llc 12312 Sw 10th Ln Miami FL 33184-2445 Ph: () - | Lasting Change Llc 1645 Palm Beach Lakes Blvd Ste 1200 West Palm Beach FL 33401-2214 Ph: (561) 788-3113 |
| NPI Number | 1790357614 |
|---|---|
| Provider Enumeration Date | 07/12/2021 |
| Last Update Date | 07/12/2021 |
| Certification Date | 07/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790357614 | NPI | - | NPPES |
| 018015100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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