Provider Demographics
NPI:1326495060
Name:INTERIAN, EUGENIA MERCEDES (BCABA 0-16-7095)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:MERCEDES
Last Name:INTERIAN
Suffix:
Gender:F
Credentials:BCABA 0-16-7095
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11767 SW 132ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4413
Mailing Address - Country:US
Mailing Address - Phone:786-422-2900
Mailing Address - Fax:
Practice Address - Street 1:11767 SW 132ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4413
Practice Address - Country:US
Practice Address - Phone:786-422-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT 1502426103K00000X
FL0-16-7095106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0-16-7095OtherBACB