Provider Demographics
NPI:1750053237
Name:LORET DE MOLA ZUMBADO, SIMONE (RBT)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:
Last Name:LORET DE MOLA ZUMBADO
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 1:2514 HOLLYWOOD BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6637
Mailing Address - Country:US
Mailing Address - Phone:770-568-4222
Mailing Address - Fax:
Practice Address - Street 1:7925 CARLYLE AVE APT 404
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-1985
Practice Address - Country:US
Practice Address - Phone:770-568-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-123018106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician