Healthcare Provider Details

I. General information

NPI: 1477119063
Provider Name (Legal Business Name): IBET SOCARRAS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 DARTMOUTH DR
MIDDLEBURG FL
32068-6564
US

IV. Provider business mailing address

1702 DARTMOUTH DR
MIDDLEBURG FL
32068-6564
US

V. Phone/Fax

Practice location:
  • Phone: 786-419-2316
  • Fax:
Mailing address:
  • Phone: 786-419-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number19-83513
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: