Provider Demographics
NPI:1093164469
Name:MORALES FRAGINALS, ELAINE (BCBA)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:MORALES FRAGINALS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25157 SW 108TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6354
Mailing Address - Country:US
Mailing Address - Phone:786-616-4689
Mailing Address - Fax:786-615-6624
Practice Address - Street 1:25157 SW 108TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-6354
Practice Address - Country:US
Practice Address - Phone:786-616-4689
Practice Address - Fax:786-615-6624
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL02010805106E00000X
106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017655700Medicaid