Provider Demographics
NPI:1770077745
Name:LARREA, MARIA PAULA (BCBA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:PAULA
Last Name:LARREA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 CITRUS PALM DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-4735
Mailing Address - Country:US
Mailing Address - Phone:813-420-6341
Mailing Address - Fax:
Practice Address - Street 1:8815 CITRUS PALM DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4735
Practice Address - Country:US
Practice Address - Phone:813-420-6341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-58548106S00000X
FL1-21-52108103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician