Provider Demographics
NPI:1417434424
Name:GUTIERREZ, MARILYN STEPHANIE (RBT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:STEPHANIE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25362 SW 129TH CT # 807
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-9071
Mailing Address - Country:US
Mailing Address - Phone:305-724-9837
Mailing Address - Fax:
Practice Address - Street 1:25362 SW 129TH CT # 807
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-9071
Practice Address - Country:US
Practice Address - Phone:305-724-9837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-10775106E00000X
FLRBT-18-47156106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician