Provider Demographics
NPI:1700233665
Name:PRADO CANTO, NELSON
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:PRADO CANTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 LEE BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1303
Mailing Address - Country:US
Mailing Address - Phone:239-888-0561
Mailing Address - Fax:239-360-8924
Practice Address - Street 1:3507 LEE BLVD STE 212
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1303
Practice Address - Country:US
Practice Address - Phone:239-888-0561
Practice Address - Fax:239-360-8924
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X, 103K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst