Provider Demographics
NPI:1275033037
Name:MAQUEIRA FONTE, CATISLEIDYS
Entity Type:Individual
Prefix:
First Name:CATISLEIDYS
Middle Name:
Last Name:MAQUEIRA FONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CATISLEIDYS
Other - Middle Name:N/A
Other - Last Name:MAQUEIRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BEHAVIOR TECHNICIAN
Mailing Address - Street 1:304 W 19TH ST APT REAR
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2533
Mailing Address - Country:US
Mailing Address - Phone:786-612-2778
Mailing Address - Fax:
Practice Address - Street 1:304 W 19TH ST APT REAR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2533
Practice Address - Country:US
Practice Address - Phone:786-612-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-129312106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107962100Medicaid