Provider Demographics
NPI:1689284135
Name:PRIMERA, MARIA ISABEL (RBT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:PRIMERA
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 1:13536 TURTLE MARSH LOOP APT 524
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6621
Mailing Address - Country:US
Mailing Address - Phone:954-479-4719
Mailing Address - Fax:
Practice Address - Street 1:8617 E COLONIAL DR STE 1600
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-3937
Practice Address - Country:US
Practice Address - Phone:407-968-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT20127634106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician