Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 103K00000X | Behavior Analyst | 1-21-50434 | FL |
N | 106E00000X | Assistant Behavior Analyst | FL | |
N | 106S00000X | Behavior Technician | RBT-19-99223 | FL |
NPI | 1023659661 |
---|---|
Provider Name | Ismaray Remedios Probance |
First Address | Fort Myers, FL 33907-3065 |
Second Address | Fort Myers, FL 33907-3065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2019 |
Last Update Date | 30/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RBT-19-99223 | BEHAVIOR ANALYST CERTIFICATION BOARD (01) |