Provider Demographics
NPI:1821342015
Name:ABUTOG-MANON, MA KATRINA (BCBA)
Entity Type:Individual
Prefix:
First Name:MA KATRINA
Middle Name:
Last Name:ABUTOG-MANON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:MANON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:290 NW 69TH AVE APT 169
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2322
Mailing Address - Country:US
Mailing Address - Phone:305-720-8883
Mailing Address - Fax:305-720-8883
Practice Address - Street 1:290 NW 69TH AVE APT 169
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2322
Practice Address - Country:US
Practice Address - Phone:305-720-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-18-32932103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst