Provider Demographics
NPI:1881242139
Name:JURADO, MARIELLA (BCBA)
Entity type:Individual
Prefix:MRS
First Name:MARIELLA
Middle Name:
Last Name:JURADO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17880 NE 31ST CT APT 2102
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-5007
Mailing Address - Country:US
Mailing Address - Phone:786-238-6053
Mailing Address - Fax:
Practice Address - Street 1:3675 N COUNTRY CLUB DR APT 509
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1705
Practice Address - Country:US
Practice Address - Phone:786-238-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-17-45750106S00000X
FLBACB408067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician