Provider Demographics
NPI:1780421156
Name:IGLESIAS, AHMED (MS, EDS, BCBA)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:
Credentials:MS, EDS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7158 GULF CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-3390
Mailing Address - Country:US
Mailing Address - Phone:813-507-7055
Mailing Address - Fax:
Practice Address - Street 1:151 N NOB HILL RD # 139
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1708
Practice Address - Country:US
Practice Address - Phone:561-486-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 390200000X
1-24-78500103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program