Healthcare Provider Details

I. General information

NPI: 1730704180
Provider Name (Legal Business Name): DIAMANTE ROSA ALFONSO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NW 5TH ST
CAPE CORAL FL
33993-2300
US

IV. Provider business mailing address

8359 BEACON BLVD STE 416
FORT MYERS FL
33907-3065
US

V. Phone/Fax

Practice location:
  • Phone: 239-600-8171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT20121212
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-25-84979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: