Provider Demographics
NPI:1598266686
Name:CASAS, BEATRIZ D
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:D
Last Name:CASAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 PALM AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4388
Mailing Address - Country:US
Mailing Address - Phone:786-806-8925
Mailing Address - Fax:
Practice Address - Street 1:27501 S DIXIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:NARANJA
Practice Address - State:FL
Practice Address - Zip Code:33032-8219
Practice Address - Country:US
Practice Address - Phone:305-431-8534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC-226-064-96-919-0Medicaid