Provider Demographics
NPI:1841857232
Name:MARIN, DAYRA LISSETT (BCBA# 1-21-51671)
Entity type:Individual
Prefix:
First Name:DAYRA
Middle Name:LISSETT
Last Name:MARIN
Suffix:
Gender:F
Credentials:BCBA# 1-21-51671
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24864 SW 129TH PATH
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5795
Mailing Address - Country:US
Mailing Address - Phone:786-720-0887
Mailing Address - Fax:
Practice Address - Street 1:1883 W FLAGLER ST STE 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1969
Practice Address - Country:US
Practice Address - Phone:786-720-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
19-83331106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician