Provider Demographics
NPI:1407427107
Name:CRUZ QUETELL, RICHELLE M (BCBA)
Entity type:Individual
Prefix:
First Name:RICHELLE
Middle Name:M
Last Name:CRUZ QUETELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1509 E COLONIAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4729
Mailing Address - Country:US
Mailing Address - Phone:407-317-5429
Mailing Address - Fax:321-800-7201
Practice Address - Street 1:1200 E PLANT ST STE 120
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2952
Practice Address - Country:US
Practice Address - Phone:407-317-5429
Practice Address - Fax:321-800-7201
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-23-69447103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst