Provider Demographics
NPI:1255080370
Name:SOSSA-DIAZ, TIFFANY (RBT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SOSSA-DIAZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7533 CAMPANIA WAY UNIT 311
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6694
Mailing Address - Country:US
Mailing Address - Phone:813-397-9186
Mailing Address - Fax:
Practice Address - Street 1:7533 CAMPANIA WAY UNIT 311
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-6694
Practice Address - Country:US
Practice Address - Phone:813-397-9186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-200524106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician