Provider Demographics
NPI:1083294268
Name:CRUZ PEREZ, SUSANA AIMEE (RBT)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:AIMEE
Last Name:CRUZ PEREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 TREVOR CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-5209
Mailing Address - Country:US
Mailing Address - Phone:561-827-5126
Mailing Address - Fax:
Practice Address - Street 1:2486 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5229
Practice Address - Country:US
Practice Address - Phone:561-827-5126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician