Provider Demographics
NPI:1629889183
Name:SUAREZ BETANCOURT, GRISIS LUCIA
Entity type:Individual
Prefix:
First Name:GRISIS
Middle Name:LUCIA
Last Name:SUAREZ BETANCOURT
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 1:14605 FOSSIL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4918
Mailing Address - Country:US
Mailing Address - Phone:689-326-1547
Mailing Address - Fax:
Practice Address - Street 1:14605 FOSSIL CREEK CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4918
Practice Address - Country:US
Practice Address - Phone:689-326-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-401886106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician