Provider Demographics
NPI:1982179578
Name:PAIFER, IBIS (BCBA)
Entity Type:Individual
Prefix:
First Name:IBIS
Middle Name:
Last Name:PAIFER
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 1:13246 SW 86TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4161
Mailing Address - Country:US
Mailing Address - Phone:786-930-5840
Mailing Address - Fax:
Practice Address - Street 1:13370 SW 131ST ST STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5856
Practice Address - Country:US
Practice Address - Phone:786-581-9644
Practice Address - Fax:305-290-5902
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-19-38783103K00000X
CBHCM100340171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst