Provider Demographics
NPI:1871241109
Name:HAZEL, ROBIN FELICITY (BCBA)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:FELICITY
Last Name:HAZEL
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 1:18051 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5203
Mailing Address - Country:US
Mailing Address - Phone:310-384-1530
Mailing Address - Fax:954-743-0203
Practice Address - Street 1:3900 HOLLYWOOD BLVD STE 303
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6797
Practice Address - Country:US
Practice Address - Phone:310-384-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-22-58397103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst