Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-20-11523 | FL |
N | 106S00000X | Behavior Technician | RBT-19-85377 | FL |
NPI | 1134541162 |
---|---|
Provider Name | Miss Gisel Fuentes Morales |
First Address | Stuart, FL 34994-4556 |
Second Address | Stuart, FL 34994-4556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2014 |
Last Update Date | 18/11/2020 |