Provider Demographics
NPI:1629610191
Name:AMONDARAIN, BRUNA FLORENCIA (RBT)
Entity Type:Individual
Prefix:
First Name:BRUNA
Middle Name:FLORENCIA
Last Name:AMONDARAIN
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 1:7170 SW 17TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1611
Mailing Address - Country:US
Mailing Address - Phone:786-930-8095
Mailing Address - Fax:
Practice Address - Street 1:7170 SW 17TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1611
Practice Address - Country:US
Practice Address - Phone:786-930-8095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-97375106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-19-97375OtherBEHAVIOR ANALYST CERTIFICATION BOARD