Provider Demographics
NPI:1336614395
Name:BUENO, PAULA ANDREA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ANDREA
Last Name:BUENO
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 1:340 CRESTWOOD CIR APT 208
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4977
Mailing Address - Country:US
Mailing Address - Phone:561-396-6199
Mailing Address - Fax:
Practice Address - Street 1:5180 W ATLANTIC AVE STE 114
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-8103
Practice Address - Country:US
Practice Address - Phone:561-926-2537
Practice Address - Fax:561-200-5595
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst