Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-21-57249 | FL |
N | 106E00000X | Assistant Behavior Analyst | 0-19-10447 | FL |
NPI | 1023516267 |
---|---|
Provider Name | Teresa Puebla |
First Address | Coral Springs, FL 33065-4533 |
Second Address | Homestead, FL 33035-1173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2018 |
Last Update Date | 08/01/2022 |