Provider Demographics
NPI:1659948487
Name:CARRACELAS VARGAS, DAMIAN (RBT-21-157436)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:
Last Name:CARRACELAS VARGAS
Suffix:
Gender:M
Credentials:RBT-21-157436
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9970 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-3267
Mailing Address - Country:US
Mailing Address - Phone:786-608-8850
Mailing Address - Fax:
Practice Address - Street 1:9970 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-3267
Practice Address - Country:US
Practice Address - Phone:786-608-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-157436106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician