Provider Demographics
NPI:1083912679
Name:KOURACLES, BEATRIZ ELIZABETH (MBA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:ELIZABETH
Last Name:KOURACLES
Suffix:
Gender:F
Credentials:MBA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 NW 67TH ST
Mailing Address - Street 2:UNIT 208
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2938
Mailing Address - Country:US
Mailing Address - Phone:617-470-9827
Mailing Address - Fax:561-372-2651
Practice Address - Street 1:440 NW 67TH ST
Practice Address - Street 2:UNIT 208
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2938
Practice Address - Country:US
Practice Address - Phone:617-470-9827
Practice Address - Fax:561-372-2651
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272103K00000X
251S00000X
CO01-13-13570103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015371600Medicaid