Provider Demographics
NPI:1710563069
Name:CARRODEGUAS HERNANDEZ, DULCE MARIA (RBT)
Entity Type:Individual
Prefix:
First Name:DULCE
Middle Name:MARIA
Last Name:CARRODEGUAS HERNANDEZ
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 1:303 NW 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4054
Mailing Address - Country:US
Mailing Address - Phone:786-585-6430
Mailing Address - Fax:
Practice Address - Street 1:303 NW 35TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4054
Practice Address - Country:US
Practice Address - Phone:786-585-6430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-129154106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109727100Medicaid