Provider Demographics
NPI:1760150825
Name:PALACIO, GERTRUDIS (RBT)
Entity Type:Individual
Prefix:
First Name:GERTRUDIS
Middle Name:
Last Name:PALACIO
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 1:585 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3643
Mailing Address - Country:US
Mailing Address - Phone:786-520-9247
Mailing Address - Fax:
Practice Address - Street 1:585 E 28TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3643
Practice Address - Country:US
Practice Address - Phone:786-520-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT21-1751316106S00000X
FLRBT21-175136106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician