Provider Demographics
NPI:1942045075
Name:UNIQUE BEHAVIORAL PRACTICE CORP
Entity type:Organization
Organization Name:UNIQUE BEHAVIORAL PRACTICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PI SAGION
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:561-543-7896
Mailing Address - Street 1:3620 COLONIAL BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1066
Mailing Address - Country:US
Mailing Address - Phone:561-543-7896
Mailing Address - Fax:
Practice Address - Street 1:3620 COLONIAL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1066
Practice Address - Country:US
Practice Address - Phone:561-543-7896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty