Healthcare Provider Details

I. General information

NPI: 1780449074
Provider Name (Legal Business Name): RICHARD PRIETO SOUTO BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SHERIDAN ST STE 108
PEMBROKE PINES FL
33024-8802
US

IV. Provider business mailing address

9000 SHERIDAN ST STE 108
PEMBROKE PINES FL
33024-8802
US

V. Phone/Fax

Practice location:
  • Phone: 954-862-2237
  • Fax:
Mailing address:
  • Phone: 954-862-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89597
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: