Provider Demographics
NPI:1710567193
Name:CASTANEDA, DORIS (RBT)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:
Last Name:CASTANEDA
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 1:701 NW 111TH CT APT 6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-3783
Mailing Address - Country:US
Mailing Address - Phone:813-450-9648
Mailing Address - Fax:
Practice Address - Street 1:93911 OVERSEAS HWY STE 8
Practice Address - Street 2:
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-3025
Practice Address - Country:US
Practice Address - Phone:786-419-9609
Practice Address - Fax:305-418-7419
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-157304106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty