Provider Demographics
NPI:1407561079
Name:QURESHI, MARIAM (RBT-22-209979)
Entity Type:Individual
Prefix:MISS
First Name:MARIAM
Middle Name:
Last Name:QURESHI
Suffix:
Gender:F
Credentials:RBT-22-209979
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11276 SW 232ND ST
Mailing Address - Street 2:
Mailing Address - City:GOULDS
Mailing Address - State:FL
Mailing Address - Zip Code:33170-7505
Mailing Address - Country:US
Mailing Address - Phone:305-912-8399
Mailing Address - Fax:305-508-6537
Practice Address - Street 1:11276 SW 232ND ST
Practice Address - Street 2:
Practice Address - City:GOULDS
Practice Address - State:FL
Practice Address - Zip Code:33170-7505
Practice Address - Country:US
Practice Address - Phone:305-912-8399
Practice Address - Fax:305-508-6537
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-209979106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician