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General NPI Number Information
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NPI Number | 1033727094
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Entity Type | Individual
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Provider Name | SOFIA BAYLAC MINGO BCBA, MS
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Gender | Female
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 12/01/2024
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Provider Practice Location Address
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Address Line | 333 W 41ST ST STE 414
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City | MIAMI BEACH
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State | FL
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Zip | 33140-3608
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Country | US
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Telephone | 786-673-9355
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Fax |
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Provider Business Mailing Address
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Address Line | 3624 TREE RIDGE LN NE
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City | PALM BAY
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State | FL
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Zip | 32905-4663
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Country | US
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Telephone | 954-592-3295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-90259
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-77432
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License Number State |
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