Provider Demographics
NPI:1912770421
Name:ELIZALDE BARRIOS, WILLIAM (RBT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ELIZALDE BARRIOS
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9326 HAITIAN DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1646
Mailing Address - Country:US
Mailing Address - Phone:754-235-9113
Mailing Address - Fax:
Practice Address - Street 1:10379 SW 186TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6824
Practice Address - Country:US
Practice Address - Phone:786-250-5165
Practice Address - Fax:786-250-5158
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-309241106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty