Provider Demographics
NPI:1174001994
Name:COLE, KAZMAR A (RBT)
Entity Type:Individual
Prefix:
First Name:KAZMAR
Middle Name:A
Last Name:COLE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15917 BRADICKS CT
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7906
Mailing Address - Country:US
Mailing Address - Phone:305-968-8951
Mailing Address - Fax:
Practice Address - Street 1:2202 MANDARIN LOOP
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4387
Practice Address - Country:US
Practice Address - Phone:833-969-2423
Practice Address - Fax:863-869-6727
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-61508106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103588700Medicaid