Provider Demographics
NPI:1205395696
Name:DUBREUZE, CHANDLY II (BCABA)
Entity Type:Individual
Prefix:
First Name:CHANDLY
Middle Name:
Last Name:DUBREUZE
Suffix:II
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8785 SW 165TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5827
Mailing Address - Country:US
Mailing Address - Phone:786-206-6500
Mailing Address - Fax:
Practice Address - Street 1:8785 SW 165TH AVE # 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33188-5827
Practice Address - Country:US
Practice Address - Phone:786-206-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-22-13999106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-19-77706OtherBEHAVIOR ANAYLYST CERTIFICATION BOARD