Provider Demographics
NPI:1093961740
Name:CARBONELL, CHRISTIAN RUBY (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:RUBY
Last Name:CARBONELL
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 1:12801 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5300
Mailing Address - Country:US
Mailing Address - Phone:305-469-3603
Mailing Address - Fax:
Practice Address - Street 1:12801 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5300
Practice Address - Country:US
Practice Address - Phone:305-469-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FL0-02-0435 CERTIFICAT252Y00000X
FL1-09-6542103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency