| The Shaping Academy For Behavioral Development | |
|
12930 Sw 128th St Suite 204a1 Miami FL 33186-6038 | |
| (305) 562-4683 | |
| (866) 517-3411 |
| Full Name | The Shaping Academy For Behavioral Development |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 12930 Sw 128th St, Miami, Florida |
| Authorized Official Name and Position | Yanivis Gonzalez (CEO) |
| Authorized Official Contact | 3055624683 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Shaping Academy For Behavioral Development 12930 Sw 128th St Suite 204a1 Miami FL 33186-6038 Ph: (305) 562-4683 | The Shaping Academy For Behavioral Development 12930 Sw 128th St Suite 204a1 Miami FL 33186-6038 Ph: (305) 562-4683 |
| NPI Number | 1710157052 |
|---|---|
| Provider Enumeration Date | 03/03/2008 |
| Last Update Date | 09/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710157052 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | MH 11547 (Florida) | Primary |
| 251S00000X | Community/behavioral Health | 1-12-10380 (Florida) | Secondary |
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