Healthcare Provider Details

I. General information

NPI: 1326691353
Provider Name (Legal Business Name): MRS. MARIA E SANCHEZ CARRILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 W ATLANTIC AVE STE 112
DELRAY BEACH FL
33484-8103
US

IV. Provider business mailing address

5180 W ATLANTIC AVE STE 112
DELRAY BEACH FL
33484-8103
US

V. Phone/Fax

Practice location:
  • Phone: 561-674-9996
  • Fax: 561-450-6972
Mailing address:
  • Phone: 561-674-9996
  • Fax: 561-450-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-91316
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-21-12778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: