Provider Demographics
NPI:1659924280
Name:DE ARA, CHRISTOPHER MICHAEL I (RBT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:DE ARA
Suffix:I
Gender:M
Credentials:RBT
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:M
Other - Last Name:DE ARA
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:13541 SW 62ND ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5092
Mailing Address - Country:US
Mailing Address - Phone:786-486-2968
Mailing Address - Fax:
Practice Address - Street 1:13541 SW 62ND ST APT 6
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5092
Practice Address - Country:US
Practice Address - Phone:786-486-2968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1983514106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician