Provider Demographics
NPI:1477325488
Name:CESAR, ANTHONY ROODY
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ROODY
Last Name:CESAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 SE OAKLYN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5227
Mailing Address - Country:US
Mailing Address - Phone:561-425-4311
Mailing Address - Fax:
Practice Address - Street 1:2533 SE OAKLYN ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5227
Practice Address - Country:US
Practice Address - Phone:561-425-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-296204106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician