Provider Demographics
NPI:1275288623
Name:STEVENS, RICHARD TYLER (RBT, MED)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TYLER
Last Name:STEVENS
Suffix:
Gender:M
Credentials:RBT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S DOUGLAS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4108
Mailing Address - Country:US
Mailing Address - Phone:703-727-2116
Mailing Address - Fax:
Practice Address - Street 1:44933 GEORGE WASHINGTON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-6301
Practice Address - Country:US
Practice Address - Phone:571-520-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-22-201301106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-22-201301OtherRBT-22-201301