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Organization
DRA BEHAVIORAL HEALTH CORP
Active
Organization
DRA BEHAVIORAL HEALTH CORP
Active
Parent organization
940003472951
Other names
n/a
Organization subpart
Yes
Provider details
NPI number
Legal business name
940003472951
Authorized official
DAISY RAVELO INTERN MFT (PRESIDENT)
(954) 394-2835
Entity
Organization
Contact information
Practice address
6107 PALM DR, FORT PIERCE, FL 34982-7577
(954) 394-2835
Mailing address
6107 PALM DR, FORT PIERCE, FL 34982-7577
(954) 394-2835
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
SW2625
FL
251V00000X
Voluntary or Charitable Agency
59748
FL
252Y00000X
Early Intervention Provider Agency
SW 2625
FL
305S00000X
Point of Service
59748
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IMT 416
INTERN MFT
FL
01
—
SW2625
SW
FL
Enumeration date
02/22/2016
Last updated
03/30/2017
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