Provider Demographics
NPI:1215403688
Name:GUTIERREZ IBANEZ, DARLYS (BCBA)
Entity Type:Individual
Prefix:
First Name:DARLYS
Middle Name:
Last Name:GUTIERREZ IBANEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10073 SW 157TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-6141
Mailing Address - Country:US
Mailing Address - Phone:786-308-0085
Mailing Address - Fax:
Practice Address - Street 1:10073 SW 157TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-6141
Practice Address - Country:US
Practice Address - Phone:786-308-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-43962103K00000X, 103K00000X
FLRBT-17-44968106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician