Provider Demographics
NPI:1003625732
Name:SOCARRAS MANDIAROTE, ANA PAULA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:PAULA
Last Name:SOCARRAS MANDIAROTE
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 1:5460 W 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4805
Mailing Address - Country:US
Mailing Address - Phone:305-342-7514
Mailing Address - Fax:
Practice Address - Street 1:5460 W 24TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4805
Practice Address - Country:US
Practice Address - Phone:305-342-7514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-400281106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician