Healthcare Provider Details

I. General information

NPI: 1003595786
Provider Name (Legal Business Name): MARLENY SANTOS ROBERTO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2499 GLADES RD STE 109
BOCA RATON FL
33431-7260
US

IV. Provider business mailing address

2343 SW 15TH ST
MIAMI FL
33145-1205
US

V. Phone/Fax

Practice location:
  • Phone: 561-350-8592
  • Fax:
Mailing address:
  • Phone: 786-384-4972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: