Provider Demographics
NPI:1760014237
Name:ALVAREZ, MIRISLEYDIS (BCBA)
Entity Type:Individual
Prefix:
First Name:MIRISLEYDIS
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23959 SW 118TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3421
Mailing Address - Country:US
Mailing Address - Phone:786-486-3909
Mailing Address - Fax:
Practice Address - Street 1:23959 SW 118TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3421
Practice Address - Country:US
Practice Address - Phone:786-486-3909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL12363484103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician