Provider Demographics
NPI:1609225820
Name:MAS, IVETTE MABEL (BCBA RN)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:MABEL
Last Name:MAS
Suffix:
Gender:F
Credentials:BCBA RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18645 SW 291ST ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-3056
Mailing Address - Country:US
Mailing Address - Phone:786-273-6246
Mailing Address - Fax:
Practice Address - Street 1:18645 SW 291ST ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3056
Practice Address - Country:US
Practice Address - Phone:786-273-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2023-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-19-35631103K00000X, 103K00000X
CO0-18-8472106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst