Provider Demographics
NPI:1225679806
Name:MANRIQUE, PAUL MILTON (BCBA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MILTON
Last Name:MANRIQUE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 LAKE HAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-5632
Mailing Address - Country:US
Mailing Address - Phone:863-273-3182
Mailing Address - Fax:
Practice Address - Street 1:4808 LAKE HAVEN BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-5632
Practice Address - Country:US
Practice Address - Phone:863-273-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-23-67164103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty