Provider Demographics
NPI:1629853585
Name:AZEVEDO DENADAI, ROBERTA (RBT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:AZEVEDO DENADAI
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 1:730 SW 78TH AVE APT 635
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3485
Mailing Address - Country:US
Mailing Address - Phone:754-946-8180
Mailing Address - Fax:
Practice Address - Street 1:730 SW 78TH AVE APT 635
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3485
Practice Address - Country:US
Practice Address - Phone:754-946-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-293052106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician