Provider Demographics
NPI:1942365804
Name:CJA BEHAVIORAL SERVICES, LLC
Entity type:Organization
Organization Name:CJA BEHAVIORAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-483-9540
Mailing Address - Street 1:809 E OAK ST STE 105
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5834
Mailing Address - Country:US
Mailing Address - Phone:407-483-9540
Mailing Address - Fax:407-483-9551
Practice Address - Street 1:809 E OAK ST STE 105
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5834
Practice Address - Country:US
Practice Address - Phone:407-483-9520
Practice Address - Fax:407-483-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684629796Medicaid
FL684629798Medicaid
FL010316000Medicaid
FL010375100Medicaid