Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 104100000X | Social Worker | ||
N | 104100000X | Social Worker | FL | |
N | 106E00000X | Assistant Behavior Analyst | FL |
NPI | 1114172202 |
---|---|
Provider Name | Marielis La O |
First Address | Miami, FL 33193-2052 |
Second Address | Miami, FL 33193-2052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 03/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017915400 | (05) | FL |