Provider Demographics
NPI:1821634031
Name:DOMINGUEZ SUAREZ, ROBERTO A (BCBA)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:A
Last Name:DOMINGUEZ SUAREZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 SW 72ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1433
Mailing Address - Country:US
Mailing Address - Phone:786-975-3716
Mailing Address - Fax:
Practice Address - Street 1:2152 SW 72ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1433
Practice Address - Country:US
Practice Address - Phone:786-975-3716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-21-11839106E00000X
RBT-19-98644106S00000X
FL1-22-59612103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician