Provider Demographics
NPI:1629385489
Name:MARINOV, VIOLETA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:VIOLETA
Middle Name:
Last Name:MARINOV
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NE 12TH AVE APT 708
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-3641
Mailing Address - Country:US
Mailing Address - Phone:754-214-3506
Mailing Address - Fax:305-935-0820
Practice Address - Street 1:500 NE 12TH AVE APT 708
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-3641
Practice Address - Country:US
Practice Address - Phone:754-214-3506
Practice Address - Fax:305-935-0820
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-31
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-12-11481103K00000X
222Q00000X
FLSI14212355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12484771OtherCAQH