Provider Demographics
NPI:1396511903
Name:BLANCO SALAZAR, CARLENIS CAROLINA (RBT)
Entity type:Individual
Prefix:
First Name:CARLENIS
Middle Name:CAROLINA
Last Name:BLANCO SALAZAR
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 1:942 NW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4107
Mailing Address - Country:US
Mailing Address - Phone:786-557-9695
Mailing Address - Fax:
Practice Address - Street 1:942 NW 6TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4107
Practice Address - Country:US
Practice Address - Phone:786-557-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-311666106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty