Provider Demographics
NPI:1962864660
Name:DE PAULA, ROBERTA TERRES
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:TERRES
Last Name:DE PAULA
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 1:22537 SWORDFISH DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4612
Mailing Address - Country:US
Mailing Address - Phone:561-859-6213
Mailing Address - Fax:
Practice Address - Street 1:22537 SWORDFISH DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4612
Practice Address - Country:US
Practice Address - Phone:561-859-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician