Provider Demographics
NPI:1740056506
Name:CASTELLANOS CHIMBI, MARIA PATRICIA (RBT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:PATRICIA
Last Name:CASTELLANOS CHIMBI
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 1:3631 CARAMBOLA CIR N
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2412
Mailing Address - Country:US
Mailing Address - Phone:954-637-5255
Mailing Address - Fax:
Practice Address - Street 1:7301A W PALMETTO PARK RD STE 100C
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3403
Practice Address - Country:US
Practice Address - Phone:954-869-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-309-349106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty