Provider Demographics
NPI:1770175374
Name:CINTRON, STACEY S
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:S
Last Name:CINTRON
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 1:7875 NW 12TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1815
Mailing Address - Country:US
Mailing Address - Phone:786-269-3502
Mailing Address - Fax:305-468-6154
Practice Address - Street 1:15540 SW 24TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5777
Practice Address - Country:US
Practice Address - Phone:786-512-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician