Provider Demographics
NPI:1841998630
Name:HERNANDEZ CRUZ, MARISOL (RBT)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:HERNANDEZ CRUZ
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 1:10382SW 212ST APT103
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189
Mailing Address - Country:US
Mailing Address - Phone:786-277-9955
Mailing Address - Fax:
Practice Address - Street 1:10382SW 212ST APT103
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189
Practice Address - Country:US
Practice Address - Phone:786-277-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22239371106S00000X
FLRBT-22-239371106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician