Provider Demographics
NPI:1417647264
Name:VELIS BARROSO, ALINA MARGARITA (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ALINA
Middle Name:MARGARITA
Last Name:VELIS BARROSO
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 1:2017 N EAST COAST ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-6115
Mailing Address - Country:US
Mailing Address - Phone:786-740-1780
Mailing Address - Fax:
Practice Address - Street 1:2017 N EAST COAST ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33460-6115
Practice Address - Country:US
Practice Address - Phone:786-740-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-267883106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician