Provider Demographics
NPI:1669287785
Name:ALFONSO FERNANDEZ, MARIA T (RBT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:ALFONSO FERNANDEZ
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 1:12861 SW 242ND ST APT 2210
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-3180
Mailing Address - Country:US
Mailing Address - Phone:305-717-4601
Mailing Address - Fax:
Practice Address - Street 1:12861 SW 242ND ST APT 2210
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-3180
Practice Address - Country:US
Practice Address - Phone:305-717-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-25-409268106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician