Provider Demographics
NPI:1689319568
Name:STHEPEN, BLANCA ROSA
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ROSA
Last Name:STHEPEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W 53RD ST APT 14
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-8005
Mailing Address - Country:US
Mailing Address - Phone:786-720-3095
Mailing Address - Fax:
Practice Address - Street 1:1350 W 53RD ST APT 14
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-8005
Practice Address - Country:US
Practice Address - Phone:786-720-3095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-132259106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRBT-20-132259OtherBACB - BEHAVIOR ANALYST CERTIFICATION BOARD