Healthcare Provider Details

I. General information

NPI: 1871015800
Provider Name (Legal Business Name): MAIDELY DIAZ CARO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 FOREST HILL BLVD STE 3
WEST PALM BEACH FL
33406-6031
US

IV. Provider business mailing address

4069 ROBERTS WAY
LAKE WORTH FL
33463-4568
US

V. Phone/Fax

Practice location:
  • Phone: 561-444-2814
  • Fax: 561-444-2458
Mailing address:
  • Phone: 561-541-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-54850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: