Provider Demographics
NPI:1649080607
Name:ALONSO, ASHLEY MARYANN
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARYANN
Last Name:ALONSO
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 1:6931 MIAMI LAKEWAY S
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2925
Mailing Address - Country:US
Mailing Address - Phone:305-298-5113
Mailing Address - Fax:
Practice Address - Street 1:5201 BLUE LAGOON DR STE 900
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-7057
Practice Address - Country:US
Practice Address - Phone:305-310-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-11
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA452013035660106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician