Provider Demographics
NPI:1700545118
Name:COSSIO DE CASAS, CISMARY (BS)
Entity type:Individual
Prefix:
First Name:CISMARY
Middle Name:
Last Name:COSSIO DE CASAS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11591 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4326
Mailing Address - Country:US
Mailing Address - Phone:786-399-8071
Mailing Address - Fax:
Practice Address - Street 1:11591 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4326
Practice Address - Country:US
Practice Address - Phone:786-399-8071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-23-65395103K00000X
CO0-21-12325106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst