Provider Demographics
NPI:1811770936
Name:CICERO, ANA GABRIELA (RBT)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:GABRIELA
Last Name:CICERO
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 1:4476 BLUFF OAK LOOP
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2346
Mailing Address - Country:US
Mailing Address - Phone:954-494-8191
Mailing Address - Fax:
Practice Address - Street 1:103 BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5713
Practice Address - Country:US
Practice Address - Phone:407-201-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB924614106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician