Provider Demographics
NPI:1881056539
Name:DEBASA MARIMON, GRETEL (MS)
Entity type:Individual
Prefix:MRS
First Name:GRETEL
Middle Name:
Last Name:DEBASA MARIMON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1545
Mailing Address - Country:US
Mailing Address - Phone:786-384-1063
Mailing Address - Fax:
Practice Address - Street 1:10820 NW 85TH TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-1545
Practice Address - Country:US
Practice Address - Phone:786-384-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-18-9044106E00000X
FL1-21-48568103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst