Provider Demographics
NPI:1376196709
Name:AGUILAR CORZO, MARIEYIS (BCBA)
Entity Type:Individual
Prefix:
First Name:MARIEYIS
Middle Name:
Last Name:AGUILAR CORZO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14813 SW 82ND TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1562
Mailing Address - Country:US
Mailing Address - Phone:786-328-6629
Mailing Address - Fax:
Practice Address - Street 1:14813 SW 82ND TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1562
Practice Address - Country:US
Practice Address - Phone:786-328-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-36415103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019748900Medicaid