Provider Demographics
NPI:1437710795
Name:CRISSIEN, MARYORI DEL CARMEN
Entity Type:Individual
Prefix:
First Name:MARYORI
Middle Name:DEL CARMEN
Last Name:CRISSIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18844 SW 319TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-5330
Mailing Address - Country:US
Mailing Address - Phone:305-878-4916
Mailing Address - Fax:
Practice Address - Street 1:18844 SW 319TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5330
Practice Address - Country:US
Practice Address - Phone:305-878-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-89886106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician