Provider Demographics
NPI:1306186937
Name:CESPEDES, CRISTEN
Entity Type:Individual
Prefix:
First Name:CRISTEN
Middle Name:
Last Name:CESPEDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13425 SW 108TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6067
Mailing Address - Country:US
Mailing Address - Phone:786-942-3615
Mailing Address - Fax:786-942-3615
Practice Address - Street 1:13425 SW 108TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-6067
Practice Address - Country:US
Practice Address - Phone:786-942-3615
Practice Address - Fax:786-942-3615
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL0-18-9401106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician