Provider Demographics
NPI:1295336246
Name:SANTISO LAUREIRO, HAROLD
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:
Last Name:SANTISO LAUREIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5870 S 38TH CT
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4724
Mailing Address - Country:US
Mailing Address - Phone:561-814-4469
Mailing Address - Fax:
Practice Address - Street 1:5870 S 38TH CT
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4724
Practice Address - Country:US
Practice Address - Phone:561-814-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL108375600103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL180375600Medicaid
FLNAOtherNA