Provider Demographics
NPI:1275004053
Name:SANTOS, LILMARIA (RBT)
Entity Type:Individual
Prefix:
First Name:LILMARIA
Middle Name:
Last Name:SANTOS
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 1:9711 FONTAINEBLEAU BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4081
Mailing Address - Country:US
Mailing Address - Phone:786-328-4295
Mailing Address - Fax:
Practice Address - Street 1:9711 FONTAINEBLEAU BLVD APT 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4081
Practice Address - Country:US
Practice Address - Phone:786-328-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-71776106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023631300Medicaid