Provider Demographics
NPI:1184121097
Name:NODARSE, EVELIN (RBT)
Entity type:Individual
Prefix:
First Name:EVELIN
Middle Name:
Last Name:NODARSE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:EVELIN
Other - Middle Name:
Other - Last Name:NODARSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:6969 W 24TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5473
Mailing Address - Country:US
Mailing Address - Phone:305-206-8323
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:6969 W 24TH LN
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5473
Practice Address - Country:US
Practice Address - Phone:305-206-8323
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-07
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-11388106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty