Provider Demographics
NPI:1174272652
Name:FIALLO, GRETEL (RBT)
Entity Type:Individual
Prefix:
First Name:GRETEL
Middle Name:
Last Name:FIALLO
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 1:6501 GRANT CT
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5843
Mailing Address - Country:US
Mailing Address - Phone:786-624-9095
Mailing Address - Fax:
Practice Address - Street 1:6501 GRANT CT
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-5843
Practice Address - Country:US
Practice Address - Phone:786-624-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-170495106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician