Provider Demographics
NPI:1780348037
Name:FONTE LAGO, DANAIRIS (RBT)
Entity type:Individual
Prefix:
First Name:DANAIRIS
Middle Name:
Last Name:FONTE LAGO
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 1:6913 N LOIS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3855
Mailing Address - Country:US
Mailing Address - Phone:786-328-5064
Mailing Address - Fax:
Practice Address - Street 1:5820 N CHURCH AVE UNIT 121
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5640
Practice Address - Country:US
Practice Address - Phone:813-820-2314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-189803106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst