Kids Academy Therapy Center Corp

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

KIDS ACADEMY THERAPY CENTER CORP

Practice address

12553 New Brittany Blvd Ste 32
Fort Myers, FL 33907-3625

Phone

(239) 887-4205

Fax

(239) 313-6923

NPI assigned

Nov 13, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mariam Gutierrez

Title

Owner

Phone

(786) 273-6796

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Raina Burlak, MS NCC

  • Mental Health Counselor
  • Fort Myers, FL
  • NPI 1811352107
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607644800000",
    "number": "1427650563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12553 NEW BRITTANY BLVD STE 32",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073625",
            "telephone_number": "239-887-4205",
            "fax_number": "239-313-6923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12553 NEW BRITTANY BLVD STE 32",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073625",
            "telephone_number": "239-887-4205",
            "fax_number": "239-313-6923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS ACADEMY THERAPY CENTER CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-13",
        "last_updated": "2020-12-11",
        "certification_date": "2020-11-13",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "786-273-6796"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sandi Lwin Khin, M.D.
• Banafsheh Kiankhooy Fard, M.D.
• Kid Spirit, Inc.
• Kid Talk Speech Therapy Services Inc
• Kidd Family Chiropractic LLC
• Kidspace Behavioral Therapy LLC
• Kidz Pediatric Multispecialty
• Elisabeth Kieffer, M.A., L.M.H.C.
• Anjanet Kiesel, MA, LMHC
• Yolanda Kieser, DMD

• Behavior Analyst in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.