Provider Demographics
NPI:1801309380
Name:BAEZ, ELIZABETH SARAI (BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SARAI
Last Name:BAEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SARAI
Other - Last Name:MARTINEZ GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9240 SW 178TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5745
Mailing Address - Country:US
Mailing Address - Phone:305-922-8994
Mailing Address - Fax:
Practice Address - Street 1:9240 SW 178TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5745
Practice Address - Country:US
Practice Address - Phone:305-922-8994
Practice Address - Fax:305-256-1663
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-07
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst