Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | M610104966220 | FL |
NPI | 1063944130 |
---|---|
Provider Name | Ms. Charlotte Da Cruz Mirebeau |
First Address | Miami, FL 33130-2996 |
Second Address | Hialeah, FL 33012-3657 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 29/03/2017 |