Provider Demographics
NPI:1609655505
Name:RODRIGUEZ SUAREZ, LAURA LORENA (RBT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LORENA
Last Name:RODRIGUEZ SUAREZ
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 1:8334 JACKSON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2813
Mailing Address - Country:US
Mailing Address - Phone:813-897-5413
Mailing Address - Fax:
Practice Address - Street 1:8334 JACKSON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2813
Practice Address - Country:US
Practice Address - Phone:813-897-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-23-297543106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician