Provider Demographics
NPI:1538873906
Name:REINFORCE AND MODIFY LLC
Entity type:Organization
Organization Name:REINFORCE AND MODIFY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:MILAGROS
Authorized Official - Last Name:FUENTES DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-510-3772
Mailing Address - Street 1:8209 MALVERN CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2242
Mailing Address - Country:US
Mailing Address - Phone:863-510-3772
Mailing Address - Fax:
Practice Address - Street 1:8209 MALVERN CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-2242
Practice Address - Country:US
Practice Address - Phone:863-510-3772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty