Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-20-11431 | FL |
NPI | 1104414796 |
---|---|
Provider Name | Amanda Bances Broche |
First Address | Miami, FL 33133-2025 |
Second Address | Miami, FL 33133-2025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2021 |
Last Update Date | 08/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108669800 | (05) | FL |