Provider Demographics
NPI:1932683968
Name:SUARES, TELMA A (BCBA)
Entity Type:Individual
Prefix:
First Name:TELMA
Middle Name:A
Last Name:SUARES
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 1:4263 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-5028
Mailing Address - Country:US
Mailing Address - Phone:954-882-2142
Mailing Address - Fax:
Practice Address - Street 1:4263 NEVADA ST
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-5028
Practice Address - Country:US
Practice Address - Phone:954-882-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-21-48094103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst