Provider Demographics
NPI:1932558145
Name:ROBERTO, ELLIOTT (BA)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:ROBERTO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2126
Mailing Address - Country:US
Mailing Address - Phone:305-300-6096
Mailing Address - Fax:
Practice Address - Street 1:6161 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2126
Practice Address - Country:US
Practice Address - Phone:305-300-6096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst