Provider Demographics
NPI:1154056174
Name:FREIRE-BLANCO, SARA ISABEL (RBT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ISABEL
Last Name:FREIRE-BLANCO
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 1:9581 FOUNTAINBLEAU BLVD APT 410
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6849
Mailing Address - Country:US
Mailing Address - Phone:786-308-5063
Mailing Address - Fax:
Practice Address - Street 1:9581 FOUNTAINBLEAU BLVD APT 410
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-6849
Practice Address - Country:US
Practice Address - Phone:786-308-5063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
22-223860106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician