NPIMap

Organization Active NPI

MMD Professional Services, Corp.

  • Behavior Analyst
  • Port St Lucie, FL
National Provider Identifier
1740926757
Registry record updated May 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Legal business name
MMD PROFESSIONAL SERVICES, CORP.
Practice address
1680 SW Bayshore Blvd Ste 100
Port St Lucie, FL 34984-3518
Phone
(772) 610-3947
Fax
(772) 610-3952
NPI assigned
May 11, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2022

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

Authorized official

Name
Miguel A Garcia
Title
Clinical Director
Phone
(786) 715-7072

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X SINGLE SPECIALTY GROUP 103K00000X Primary

Addresses

Primary practice location

1680 SW Bayshore Blvd Ste 100
Port St Lucie, FL 34984-3518

Mailing address

1680 SW Bayshore Blvd Ste 100
Port St Lucie, FL 34984-3518
Phone (772) 610-3947

National Provider Directory

National Provider Directory
Tax ID family
MMD Professional Services Corp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1680 SW Bayshore Blvd
Ste 100
Port St Lucie, FL 34984
Phone (772) 610-3947

NPI Registry JSON

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

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652227200000",
    "number": "1740926757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1680 SW BAYSHORE BLVD STE 100",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349843518",
            "telephone_number": "772-610-3947",
            "fax_number": "772-610-3952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 SW BAYSHORE BLVD STE 100",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349843518",
            "telephone_number": "772-610-3947",
            "fax_number": "772-610-3952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMD PROFESSIONAL SERVICES, CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-11",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "786-715-7072"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port St Lucie, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; 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.