Provider Demographics
NPI:1043941552
Name:BERROA, JOEL (RBT CERTIFIED)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:
Last Name:BERROA
Suffix:
Gender:M
Credentials:RBT CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6533 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2229
Mailing Address - Country:US
Mailing Address - Phone:727-534-3234
Mailing Address - Fax:
Practice Address - Street 1:6533 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2229
Practice Address - Country:US
Practice Address - Phone:727-534-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-221639106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111483900Medicaid