Provider Demographics
NPI:1558045674
Name:MORENO FULGUEIRO, GREISY (RBT-23-271653)
Entity Type:Individual
Prefix:
First Name:GREISY
Middle Name:
Last Name:MORENO FULGUEIRO
Suffix:
Gender:F
Credentials:RBT-23-271653
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33909-9202
Mailing Address - Country:US
Mailing Address - Phone:239-895-2186
Mailing Address - Fax:
Practice Address - Street 1:1621 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-9202
Practice Address - Country:US
Practice Address - Phone:239-895-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-271653106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician