Provider Demographics
NPI:1558901298
Name:MUNOZ ACOSTA, AGLAY (RBT)
Entity Type:Individual
Prefix:
First Name:AGLAY
Middle Name:
Last Name:MUNOZ ACOSTA
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 1:10000 KERSEY ST APT 10214
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-9609
Mailing Address - Country:US
Mailing Address - Phone:786-608-1733
Mailing Address - Fax:
Practice Address - Street 1:10000 KERSEY ST APT 10214
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-9609
Practice Address - Country:US
Practice Address - Phone:786-608-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-101195106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician