Provider Demographics
NPI:1477203495
Name:DIAZ ABREU, LAURA ISABEL (RBT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ISABEL
Last Name:DIAZ ABREU
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 1:3067 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1917
Mailing Address - Country:US
Mailing Address - Phone:786-370-8034
Mailing Address - Fax:
Practice Address - Street 1:3067 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1917
Practice Address - Country:US
Practice Address - Phone:786-370-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician