Provider Demographics
NPI:1538692637
Name:HAZEL, COLIN (RBT-16-12608)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:HAZEL
Suffix:
Gender:M
Credentials:RBT-16-12608
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18051 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5203
Mailing Address - Country:US
Mailing Address - Phone:954-296-6633
Mailing Address - Fax:
Practice Address - Street 1:18051 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5203
Practice Address - Country:US
Practice Address - Phone:954-296-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-12608106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician