Individual provider Active NPI

Gladys Maria Fundora, LMHC, BCBA

  • Behavior Analyst
  • Miami, FL
National Provider Identifier
1699029934
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
BCBA19-38877
Practice address
12917 SW 133Rd Ter
Miami, FL 33186-6906
Phone
(305) 731-4067
NPI assigned
Nov 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH14818 FL
Community Health Worker 172V00000X
Behavior Analyst 103K00000X BCBA19-38877 Primary

Addresses

Primary practice location

12917 SW 133Rd Ter
Miami, FL 33186-6906

Mailing address

12917 SW 133Rd Ter
Miami, FL 33186-6906
Phone (305) 731-4067

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240509002425 FL Practitioner - Mental Health Counselor 9931540861 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH14818FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Perfect Wellness Center, Inc CurrentSince Apr 1, 2024 Accepting new patients
Renaissance Mental LLC Behavior Analyst CurrentSince Mar 27, 2025 Accepting new patients

Locations

19100 SW 106th Ave
Unit 12
Cutler Bay, FL 33157
Phone (305) 395-0281

7225 NW 25th St
Ste 214
Miami, FL 33122
Phone (305) 395-0281

18501 Pines Blvd
Ste 347
Pembroke Pines, FL 33029
Phone (786) 630-8663

18501 Pines Blvd
Ste 374375
Pembroke Pines, FL 33029
Phone (786) 630-8663

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1352332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1699029934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12917 SW 133RD TER",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331866906",
            "telephone_number": "305-731-4067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12917 SW 133RD TER",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331866906",
            "telephone_number": "305-731-4067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDORA",
        "first_name": "GLADYS",
        "middle_name": "MARIA",
        "credential": "LMHC, BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-08",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH14818",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "BCBA19-38877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

Verify at the official NPI Registry.