Healthcare Provider Details

I. General information

NPI: 1881242139
Provider Name (Legal Business Name): MARIELLA JURADO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3675 N COUNTRY CLUB DR APT 509
AVENTURA FL
33180-1705
US

IV. Provider business mailing address

17880 NE 31ST CT APT 2102
AVENTURA FL
33160-5007
US

V. Phone/Fax

Practice location:
  • Phone: 786-238-6053
  • Fax:
Mailing address:
  • Phone: 786-238-6053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB408067
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-45750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: