Provider Demographics
NPI:1578079505
Name:ROBLES, MARIA CECELIA
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:CECELIA
Last Name:ROBLES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:CECELIA
Other - Last Name:DIMICHELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:350 24TH ST NW APT B102
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2265
Mailing Address - Country:US
Mailing Address - Phone:321-230-1984
Mailing Address - Fax:
Practice Address - Street 1:350 24TH ST NW APT B102
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2265
Practice Address - Country:US
Practice Address - Phone:321-230-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ALRBT-17-44003106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician