Provider Demographics
NPI:1780451260
Name:MANRIQUE ROLDAN, NATALY (RBT)
Entity type:Individual
Prefix:
First Name:NATALY
Middle Name:
Last Name:MANRIQUE ROLDAN
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 1:17021 N BAY RD APT 1008
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3627
Mailing Address - Country:US
Mailing Address - Phone:786-631-7162
Mailing Address - Fax:
Practice Address - Street 1:17021 N BAY RD APT 1008
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-3627
Practice Address - Country:US
Practice Address - Phone:786-631-7162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB951490106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician