Provider Demographics
NPI:1154912368
Name:GARCIA ACOSTA, MABEL
Entity type:Individual
Prefix:MRS
First Name:MABEL
Middle Name:
Last Name:GARCIA ACOSTA
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 1:5529 NW 194TH CIRCLE TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6138
Mailing Address - Country:US
Mailing Address - Phone:786-343-8217
Mailing Address - Fax:
Practice Address - Street 1:5529 NW 194TH CIRCLE TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-6138
Practice Address - Country:US
Practice Address - Phone:786-343-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-30
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-140965106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty