Provider Demographics
NPI:1841066115
Name:FARIA, CRYSTIEN DANIEL
Entity type:Individual
Prefix:
First Name:CRYSTIEN
Middle Name:DANIEL
Last Name:FARIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 NANO ST APT 300
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3689
Mailing Address - Country:US
Mailing Address - Phone:407-632-3024
Mailing Address - Fax:
Practice Address - Street 1:1633 E VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3732
Practice Address - Country:US
Practice Address - Phone:689-200-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-311771106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician