Provider Demographics
NPI:1174271415
Name:FERNANDEZ-TORRES, SISSI (RBT)
Entity Type:Individual
Prefix:
First Name:SISSI
Middle Name:
Last Name:FERNANDEZ-TORRES
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 1:1111 N 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5503
Mailing Address - Country:US
Mailing Address - Phone:954-624-5781
Mailing Address - Fax:
Practice Address - Street 1:1111 N 72ND AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5503
Practice Address - Country:US
Practice Address - Phone:954-624-5781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1869905106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician