Provider Demographics
NPI:1679244081
Name:DIAZ BARROSO, DIANELYS (BCBA)
Entity Type:Individual
Prefix:
First Name:DIANELYS
Middle Name:
Last Name:DIAZ BARROSO
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 1:9121 SW 208TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3889
Mailing Address - Country:US
Mailing Address - Phone:786-768-6153
Mailing Address - Fax:
Practice Address - Street 1:9121 SW 208TH TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3889
Practice Address - Country:US
Practice Address - Phone:786-768-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-24
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-49997103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty