Provider Demographics
NPI:1164123923
Name:DE LOS SANTOS, ELIZABETH (RBT-20-115749)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DE LOS SANTOS
Suffix:
Gender:F
Credentials:RBT-20-115749
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:551-655-0299
Mailing Address - Fax:
Practice Address - Street 1:104 FLEET ST APT 1R
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2212
Practice Address - Country:US
Practice Address - Phone:551-655-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-20-115749106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst