Provider Demographics
NPI:1093567851
Name:AFONSO ZAMORA, MILENA (RBT-24-337389)
Entity Type:Individual
Prefix:
First Name:MILENA
Middle Name:
Last Name:AFONSO ZAMORA
Suffix:
Gender:F
Credentials:RBT-24-337389
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 3RD ST W
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1521
Mailing Address - Country:US
Mailing Address - Phone:239-826-5972
Mailing Address - Fax:
Practice Address - Street 1:5304 3RD ST W
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1521
Practice Address - Country:US
Practice Address - Phone:239-826-5972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-337389106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician