Provider Demographics
NPI:1922705532
Name:ESCOBAR, WILLIAM MANRIQUE (RBT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MANRIQUE
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-5358
Mailing Address - Country:US
Mailing Address - Phone:863-234-8352
Mailing Address - Fax:
Practice Address - Street 1:4005 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-5358
Practice Address - Country:US
Practice Address - Phone:863-234-8352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-253832106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician