Provider Demographics
NPI:1760923486
Name:ROUCO, BELEN D
Entity Type:Individual
Prefix:
First Name:BELEN
Middle Name:D
Last Name:ROUCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 SW 84TH ST APT 6B6
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3809
Mailing Address - Country:US
Mailing Address - Phone:786-333-6090
Mailing Address - Fax:
Practice Address - Street 1:10800 SW 84TH ST APT 6B6
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3809
Practice Address - Country:US
Practice Address - Phone:786-333-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician