Provider Demographics
NPI:1235717208
Name:DUNCAN, SANDRA GRACE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:GRACE
Last Name:DUNCAN
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 1:4191 NW 26TH ST APT 251
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2711
Mailing Address - Country:US
Mailing Address - Phone:954-515-2344
Mailing Address - Fax:
Practice Address - Street 1:1790 SW 43RD WAY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33317-5701
Practice Address - Country:US
Practice Address - Phone:954-584-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-04334106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty