Healthcare Provider Details

I. General information

NPI: 1255831491
Provider Name (Legal Business Name): CAROLINA SANTIESTEBAN MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 NW FEDERAL HWY STE 173
STUART FL
34994-1019
US

IV. Provider business mailing address

25545 SW 109TH AVE
HOMESTEAD FL
33032-6363
US

V. Phone/Fax

Practice location:
  • Phone: 954-579-7973
  • Fax:
Mailing address:
  • Phone: 786-444-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-52060
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-67992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: