Provider Demographics
NPI:1679295232
Name:METAMORPHOSIS ABA THERAPY LLC
Entity type:Organization
Organization Name:METAMORPHOSIS ABA THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:786-308-6757
Mailing Address - Street 1:11455 W FLAGLER ST APT 417
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-4014
Mailing Address - Country:US
Mailing Address - Phone:786-308-6757
Mailing Address - Fax:
Practice Address - Street 1:11455 W FLAGLER ST APT 417
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-4014
Practice Address - Country:US
Practice Address - Phone:786-308-6757
Practice Address - Fax:305-675-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty