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Organization
INTENSIVE BEHAVIOR SUPPORTS
Active
Organization
INTENSIVE BEHAVIOR SUPPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMARA NENNI BCBA (OWNER)
(727) 744-9829
Entity
Organization
Contact information
Practice address
90 CITRUS CT, PALM HARBOR, FL 34683-3702
(727) 744-9829
Mailing address
90 CITRUS CT, PALM HARBOR, FL 34683-3702
(727) 744-9829
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1000169
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011132200
MEDICAID WAIVER
FL
Enumeration date
05/20/2016
Last updated
05/20/2016
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