Provider Demographics
NPI:1275122954
Name:BURACZEWSKI, KAYLEE E (RBT)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:E
Last Name:BURACZEWSKI
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:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-0623
Mailing Address - Country:US
Mailing Address - Phone:352-999-0447
Mailing Address - Fax:352-437-4921
Practice Address - Street 1:11820 MUNBURY DR FL 33525
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5747
Practice Address - Country:US
Practice Address - Phone:352-999-0447
Practice Address - Fax:352-437-4921
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-147848106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician