Provider Demographics
NPI:1447615323
Name:ROMAN, BEATRIZ (BCBA)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:
Last Name:ROMAN
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 1:1509 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4704
Mailing Address - Country:US
Mailing Address - Phone:407-218-4371
Mailing Address - Fax:
Practice Address - Street 1:1200 E PLANT ST STE 120
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2952
Practice Address - Country:US
Practice Address - Phone:407-218-4371
Practice Address - Fax:321-800-7201
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-27582103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018125100Medicaid