Provider Demographics
NPI:1770017485
Name:ALONSO, CARMEN ROSA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ROSA
Last Name:ALONSO
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 1:8251 NW 8TH ST APT 110
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3945
Mailing Address - Country:US
Mailing Address - Phone:305-496-5642
Mailing Address - Fax:
Practice Address - Street 1:8251 NW 8TH ST APT 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3945
Practice Address - Country:US
Practice Address - Phone:305-496-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-07801106S00000X
0-20-10942106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician